Investigation and management of impaired metabolic adaptation presenting as neonatal hypoglycaemia

At birth, the newborn baby undergoes many adaptive changes to independent extrauterine life. These include the changes of metabolic adaptation, which must be understood in order to identify and manage the conditions in which metabolic adaptation is delayed, impaired or fails, resulting in low levels of glucose and other metabolic fuels, which in turn affect neonatal neurological function and, if prolonged and severe, cause potential adverse outcome. Babies identified as at risk of impaired metabolic adaptation must undergo clinical monitoring, including accurate blood glucose monitoring, tailored to their condition. Babies who present with abnormal clinical signs in association with a low blood glucose level must be investigated for underlying cause and treated promptly. Prevention and treatment of clinically significant hypoglycaemia must be planned to avoid compromising successful establishment of breast feeding.