Point-of-care glucometers are least accurate exactly where neonatal decisions are made — at the low end of the range, in babies with high haematocrit. A reading can be several mmol/L away from the true plasma value in either direction, which is why a laboratory sample should always be sent alongside.
The error that matters is waiting for it. In a symptomatic baby — jittery, poorly feeding, hypotonic, or having had a seizure — the laboratory turnaround is long enough for harm, and the treatment is safe. Treat on the point-of-care reading, send the confirmatory sample at the same time, and use the laboratory result to interpret what happened rather than to decide whether to act.
The reverse error is also worth naming: a point-of-care reading that looks acceptable in a symptomatic baby does not exclude hypoglycaemia. Where the clinical picture and the meter disagree, believe the baby.
- Send a laboratory glucose with every point-of-care reading that will change management
- Treat a symptomatic baby on the meter reading; do not wait for confirmation
- In a symptomatic baby with an acceptable meter reading, send the laboratory sample anyway
- Record the meter value, the laboratory value and the time of each — the gap between them is the audit trail
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