Wackernagel Dirk, Gustafsson Anna, Edstedt Bonamy Anna-Karin, Reims Annika, Ahlsson Fredrik, Elfving Maria, Domellöf Magnus, Hansen Pupp Ingrid
Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden.
Sachs' Children's and Youth Hospital, Södersjukhuset AB, Stockholm, Sweden.
Acta Paediatr. 2020 Jan;109(1):31-44. doi: 10.1111/apa.14955. Epub 2019 Aug 27.
Postnatal hypoglycaemia in newborn infants remains an important clinical problem where prolonged periods of hypoglycaemia are associated with poor neurodevelopmental outcome. The aim was to develop an evidence-based national guideline with the purpose to optimise prevention, diagnosis and treatment of hypoglycaemia in newborn infants with a gestational age ≥35 + 0 weeks.
A PubMed search-based literature review was used to find actual and applicable evidence for all incorporated recommendations. The GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach was used for grading the evidence of the recommendations.
Recommendations for the prevention of neonatal hypoglycaemia were extended and updated, focusing on promotion of breastfeeding as one prevention strategy. Oral dextrose gel as a novel supplemental therapy was incorporated in the treatment protocol. A new threshold-based screening and treatment protocol presented as a flow chart was developed.
An updated and evidence-based national guideline for screening and treatment of neonatal hypoglycaemia will support standardised regimes, which may prevent hypoglycaemia and the risk for hypoglycaemia-related long-term sequelae.
新生儿出生后低血糖仍然是一个重要的临床问题,长时间低血糖与不良的神经发育结局相关。本研究旨在制定一项基于证据的国家指南,以优化胎龄≥35+0周新生儿低血糖的预防、诊断和治疗。
采用基于PubMed检索的文献综述,为所有纳入的建议寻找实际且适用的证据。采用GRADE(推荐分级、评估、制定和评价)方法对建议的证据进行分级。
扩展并更新了预防新生儿低血糖的建议,重点是将促进母乳喂养作为一种预防策略。口服葡萄糖凝胶作为一种新型补充疗法被纳入治疗方案。制定了一个以新阈值为基础的筛查和治疗方案,并以流程图的形式呈现。
一项更新的、基于证据的新生儿低血糖筛查和治疗国家指南将支持标准化方案,这可能预防低血糖以及低血糖相关长期后遗症的风险。