Standards of admission capillary blood glucose levels in cesarean born neonates

Background: Neonatal hypoglycemia (NH) and cutoffs remain undefined. Our center screens all cesarean-delivered (CD) neonates for NH. We sought to define standards of admission capillary blood glucose levels (ACBGLs) in CD neonates who were at the lowest risk for hypoglycemia. Methods: Of 4947 neonates, 519 met all 14 inclusion criteria. These highly-selected neonates were apparently the healthiest, least-stressed, earliest to be admitted to nursery and at lowest-risk for hypoglycemia. For each CD, cord blood gases and glucose were determined and each infant was screened for blood glucose at nursery admission. Results: Sampling age was 41.6 +/- 15.3 minutes, a mean ACBGL of 52.3 +/- 10.7 mg/dL, and percentiles as follows: 1st percentile, 29.2; 3rd, 33.6; 5th, 35.0; 10th, 39.0; 25th, 46.0; 50th, 51.0; 75th, 58.0; 90th, 67.0; 95th, 71.0; 97th, 73.0, and 99th, 84.4. ACBGL rose significantly with increasing gestational age (P=0.004), increasing cord blood glucose (P < 0.001), decreasing cord blood pH (P < 0.001) and decreasing sampling age (P=0.027). Conclusions: Setting uniform ACBGL cutoffs for NH definition is unachievable due to the enormous heterogeneity among newborns. Hence, we provide group-based ACBGL standards in CD neonates. We propose setting ACBGL cutoffs for use in CD neonates: 1) hypoglycemia: ACBGL < 5th percentile (< 35 mg/dL); and 2) interventional hypoglycemia: ACBGL < 1st percentile (< 30 mg/dL).