BRIEF REPORTS

12. GLIM. Generalised Linear Interactive Modelling. Ver-
sion 3.77. Oxford: NAG Ltd., 1986.
13. Mehrotra N, Kumar A, Chansoria M, Kaul KJC.
Neonatal sepsis: correlation of maternal and neonatal
factors to positive bacterial cultures. Ind Pediat 1985;
22: 275-80.
14. Tyler CW, AJbers WH. Obstetric factors related to
bacteremia in the newborn infant. Am J Obstet Gynecol
1966; 94: 970-6.
15. Engle WD, Rosenfeld CR. Neutropenia in high-risk
neonates, J Pediat 1984; 105: 982-90.
16. Chandra RK. Interactions between early nutrition and
the immune system. Ciba Found Symp 1991; 156: 77-
89.

Blood Glucose Levels and Hypoglycaemia in Full Term

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Neonates During the First 48 Hours of Life
by Fatos, Tanzer, Nursel Yazar, Hidayet Yazar, and Dilara Icagasioglu
Department of Pediatrics, Cumhuriyet University, Faculty of Medicine, Sivas, Turkey

Summary
Thirty-five fall term infants (38-41 weeks' gestation) were included in the study. Infants of mothers with
complications of pregnancy, such as toxaemia, anaemia, diabetes, or hypertension were not included. AD
infants were fed during the first 3 hours of life and this was continued every 4 boors. Maternal glucose
estimation was carried out IS or 30 min before or at the time of birth. Glucose levels were measured in
all 35 newborns at the 1st, 2nd, and 3rd hour, and 14,24,36, and 48 hours before feeding. Serum glucose
levels were measured using a Reflectron Glucose Analyser. The lowest blood glucose level was seen in
the first 3 hours of life. In the first 3 hours of life there were 12 infants with glucose levels less than 30
mg/dL, but in only three of those did the hypoglycaemic level continue and require treatment (9 per cent).
We concluded that hypoglycaemia which is seen in the first 3 hours can be physiological and early
feeding appears to influence subsequent glucose values.

Introduction
Hypoglycaemia is an important problem in new-
borns?" 3 It is related to gestational age, initiation
and frequency of breast feeding, and intravenous
dextrose solution infusion in the mother during
labour and delivery. With these changes in perinatal
care, clinical experience has led some authors to
recommend that newborn blood glucose levels should
be maintained at over 40 mg/dl. However, Sexson4
recently showed that following this value would
result in a 20 per cent incidence of diagnosis of
hypoglycaemia in full term infants. Srinivasan et al.s
recently described plasma glucose values in healty
neonates, indicating that after the first 3 hours of life
plasma glucose concentrations are normally over 40
mg/dl. Our study was designed to define normal
values of serum glucose levels during the first 48
hours of life in well, full term neonates cared for
according to modern standarts.
Address for correspondence: Fatos Tanzer, MD, Kehribar
Sokalc 9/14 Mesa Ufuk, II. Sites! 06700, Cankaya, Ankara,
Turkey.
Methods
Thirty-five newborns born after normal delivery were
included in the study. All full term infants born
during the 6 months between January and April who
weighed between 2100 and 3839 g were included.
Subjects who had diabetes, oedema, hypertension,
infection, fetal distress, and drug intake during the
last 4 weeks of pregnancy in the prenatal history were
excluded. Mothers were given dextrose containing
fluid (5 per cent dextrose) during labour and delivery.
Gestation age was estimated from obstetrical
history and ley Dubowitz's score.6 There were 26
infants whose size was determined to be appropriate
for gestational age (AGA, 39.4 ±0.159 weeks) two
small for gestational age infants (SGA 39 ± 0 weeks)
and seven large for gestational age infants (LGA,
39.4 ±0.5 weeks). Vital signs of all newborns were
normal. Five-minute Apgar scores were over 7.
Capillary haematocrit levels ranged from 58 to 64
per cent. All newborns were breastfed in the first 3
hours of life and were continued to be fed at 3—4-
hour intervals. Maternal blood glucose levels 15 or 30
min before or during delivery were determined.
Blood glucose levels of newborns were determined

58 Journal of Tropical Pediatrics Vol. 43 February 1997

BRIEF REPORTS
at the first, second and third hour after birth, and
before every feeding on the 6th, 14th, 24th, 36th, and
48th hour after birth (Table 1, Fig. 1). Blood samples
were drawn in heparinized microtubes by a heelstick
and were immediately analysed by a reflactron
Glucose Analyser using the glucose oxidase method.
All infants were examined for signs of hypogly-
caemia prior to the collection of the sample. These
included lethargy, apnoea, cyanosis, poor sucking,
irritability, tremor, high pitched cry, limpness,
temperature instability, or seizures. Infants with
plasma glucose values under 30 mg/dl were consid-
ered to be at risk for hypoglycaemia regardless of the
presence of symptoms. If an infant had symptoms
and plasma glucose under 30 mg/dl treatment was
started immediately with an intravenous infusion of
200 mg/kg dextrose (2 ml/kg 10 per cent dextrose
solution) given over 1 min and followed by contin-
uous infusion of 8 mg/kg/min. A second sample was
drawn immediately before treatment.7
TABLE 1
Mean blood glucose values during the first
48 hours of life
Blood glucose
Age (mg/dl)
(hours) (MeaniSD)
1 53.05 ±3.46
2 45.91 ±3.1
3 48.57 ±3.03
6 53.57 ±2.11
14 54.14±1.68
24 58.82 ±2.12
36 60.6 ±2.63
48 62.22±1.86
Mother 99.73 ±4.68
53.05
20
3 6
Time after birth (hours)
FIG. 1. Mean blood glucose.
Journal of Tropical Pediatrics Vol. 43 February 1997
Results
The mean±SD birth weight of he 35 infants was
3200.14±93.16 g (range 2100-3839.3 g) and gesta-
tional age 39.4 ±0.5 weeks (range 39-39.4). Maternal
blood glucose levels were normal.
After 1 hour, 11 infants had plasma glucose values
under 40 mg/dl, four of whom had plasma glucose
values under 30 mg/dl. Two of these latter four
infants had hypoglycaemic symptoms (lethargy, poor
suck). The remaining two infants had no symptoms
and repeated values were over 30 mg/dl.
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At the second hour after birth, 16 infants had
plasma glucose values under 40 mg/dl, six of whom
had under 30 mg/dl, and three of these six had
symptoms. The remaining three infants had no
symptoms and repeated values were over 30 mg/dl.
At the third hour after birth, 13 infants had plasma
glucose levels under 40 mg/dl. Two infants had
symptomatic hypoglycaemia and plasma glucose
values were under 30 mg/dl at the third hour. After
3 hours, none of the infants had blood glucose values
under 30 mg/dl (Table 2).
The lowest blood glucose levels were detected
during the first 3 of life. Twelve newborns had at least
one blood glucose value below 30 mg/dl during the
first 3 hours of life. In only three of these cases did
the hypoglycaemia persist beyond 3 hours and
require treatment.
In one of the three infants who had symptomatic
hypoglycaemia at the first hour, the blood glucose
value was 25 mg/dl, and 20 mg/dl at the second hour.
This infant was treated with intravenously adminis-
tered 2 ml/kg 10 per cent dextrose. During the next
48 hours, the lowest blood glucose value recorded
was 49 mg/dl.
A second infant had a plasma glucose value of 21
mg/dl at the first hour. The 2nd and 3rd-hour blood
60.6 62.22
14 24 36 48
59

TABLE 2
Lowest blood glucose levels during the first 48 hours of
life
Blood glucose values
Hours <40 mg/dl < 30 mg/dl
1 11 4 SGA and another one had LGA, due to the
2 16 6 insufficient number of patients, no comment could
3 13 2 be made.
6 2 — Two of the three infants with symptomatic
14 3 —
24 1 __
36 3 —
glucose values were 18 mg/dl and 39 mg/dl,
respectively. At 14 hours, the blood glucose value
was found to be 29 mg/dl, and the infant was treated
with 2 ml/kg 10 per cent dextrose bolus infusion
followed by a continuous infusion of 8 mg/kg/min.
The infant was observed closely and a repeat sample
was drawn every 15 min. After 24 hours, the lowest
blood glucose level was 36 mg/dl.
A third infant had a plasma glucose value of 35
mg/dl at the first hour after birth. The 2nd, 3rd, 6th,
and 14th-hour blood glucose values were 28, 20, 42,
and 30 mg/dl, respectively. The infant was treated
with bolus IV infusion of 2 ml/kg (10 per cent
dextrose), followed by a continuous infusion of 8 mg/
kg/min. After 24 hours, the lowest blood glucose
level was 39 mg/dl.
Two infants were fed breastmilk plus formula and
one infant was fed only breastmilk.
Discussion
This study demonstrates the range for normal blood
glucose concentrations in full term neonates.
Our findings indicate that, as noted previously, the
lowest blood glucose concentration were detected
during the first 3 hours of life.8 Twelve newborns had
at least one blood glucose values below 30 mg/dl in
the first 3 hours of life. However, in three cases did
the hypoglycaemia persist beyond 3 hours and
require treatment.
On the basis of ourfindingsin this study of healthy
60
BRIEF REPORTS
full term infants, we recommend that hypoglycaemia
in full term infants may be defined as a serum glucose
concentration under 30 mg/dl in the first day of life
or under 40 mg/dl in the second day of life. In our
study the incidence of symptomatic hypoglycaemia in
infants was 9 per cent (3 of 35). Although one of the
three infants having symptomatic hypoglycaemia had
hypoglycaemia were fed formula plus breastmilk.
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The larger intake in the bottle-fed infants at the first
feeding could be reaponsible for higher post-prandial
insulin levels and insulin/glucagon ratios. The lower
3-4-hour post-prandial blood glucose concentration
in the bottle-fed infants may represent a rebound
hypoglycaemia effect.
This study indicates that metabolic adjustment and
glucose stabilization in healty full term neonates can
be expected after the first 3 hours of birth.
We concluded that hypoglycaemia, which is seen in
the first 3 hours of life can be physiological, and early
feeding appear to influence subsequent glucose
values.
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Journal of Tropical Pediatrics Vol. 43 February 1997