A 2.1 kg neonate born at 34 weeks is found to have blood glucose of 34 mg/dL on routine screening at 1 hour of life. She appears asymptomatic with good tone and feeding well. What is the MOST APPROPRIATE initial management?
- A Administer IV dextrose bolus 2 mL/kg of 10% dextrose immediately
- B Encourage early breastfeeding and recheck blood glucose in 30–60 minutes ✓
- C Start continuous IV glucose infusion at a rate of 6–8 mg/kg/min
- D Administer intramuscular glucagon 0.1 mg/kg
Explanation
In asymptomatic late preterm neonates, blood glucose of 34 mg/dL (borderline; threshold for action is typically <35–40 mg/dL in asymptomatic infants in many guidelines) can initially be managed with early enteral feeding (breastfeeding or formula) followed by glucose recheck in 30–60 minutes, provided the infant is feeding adequately and has no symptoms. IV dextrose bolus is reserved for symptomatic hypoglycemia or failure to respond to enteral feeding. Continuous IV glucose infusion is used for persistent or severe hypoglycemia. IM glucagon is a last resort. Per IAP/WHO guidelines, for asymptomatic neonates with glucose 25–45 mg/dL, enteral feeding is the preferred first step.
Reference: Ghai Essential Pediatrics, 10th ed.
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Written and medically reviewed by the StethoPrep medical team.