In an at-risk newborn with low glucose but no symptoms, the first step is a feed — ideally at the breast, with skin-to-skin contact — and buccal 40% dextrose gel where available, at 200 mg/kg (0.5 mL/kg) massaged into the inner cheek. Recheck glucose about 30 minutes after the feed. Symptoms such as seizures, lethargy or poor feeding, or glucose that stays low despite these measures, need IV dextrose.
- Feed first; keep the baby skin-to-skin with the mother.
- Dextrose gel 40%: 0.5 mL/kg buccally, then feed.
- Recheck glucose about 30 minutes after intervention.
- Symptomatic or persistent hypoglycaemia needs IV dextrose and senior review.
Why it matters
Most hypoglycaemic newborns can be treated without separating them from their mothers.
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