Postnatal metabolic adaptation and neonatal hypoglycaemia

Blood glucose levels fall in the hours after birth in all babies but for most babies the normal process of neonatal metabolic adaptation mobilises alternative fuels (e.g. ketone bodies) from stores so that the physiological fall in blood glucose is tolerated. However, some babies are at risk of impaired neonatal metabolic adaptation and for these babies it is important to prevent hypoglycaemia, to recognise clinically significant hypoglycaemia, and to treat it without causing unnecessary separation of mother and baby or disruption of breast feeding. This article aims to provide paediatricians with an understanding of the science underpinning best practice and offers a plan of investigation for babies in whom hypoglycaemia is persistent, resistant or unexpected.