Hypoglycaemia remains one of the leading causes of term admission to neonatal units. Significant time is expended by clinical teams in managing infants at risk of hypoglycaemia. Challenges remain in differentiating physiological falls in glucose concentrations from a potentially preventable cause of brain injury. The current evidence for distinguishing physiological from pathological hypoglycaemia remains limited by reliance on single point values of blood glucose (BG). Srinivasan et al 1 demonstrated a postnatal nadir in glucose concentrations, rising to values typical of older children by 48 hours of age. However, these infants were predominantly bottle fed (15% breast fed) and in a hospital nursery. In contrast, the Glucose in well babies (GLOW) study2 followed a cohort of term infants, all appropriately grown, predominantly breast feeding and at home. Uniquely, they also used both continuous glucose monitoring (CGM) and point of care (POC) measurement of alternative fuels to explor

An infant was born at 27 weeks’ gestation weighing 930 g. The umbilical venous catheter (UVC) initially projected over T5 (cardiac silhouette) on X-ray requiring adjustment to T10 (inferior vena cava). Benzylpenicillin and gentamicin were administered for 5 days to cover early-onset infection. Initial FBC was normal. Lethargy and hyperglycaemia prompted a sepsis screen, the removal of UVC and the initiation of ceftazidime with vancomycin (day 9). Blood tests demonstrated a raised C-reactive-protein (67 mg/dL) and thrombocytopenia (6×109/L). Blood …

A single course of antenatal corticosteroids (ANCs), when administered to women at risk of preterm birth, reduces perinatal and neonatal deaths and respiratory distress syndrome. The course probably also reduces the risk of intraventricular haemorrhage and improves neurodevelopmental outcomes in the offspring. Commonly used regimens of ANC consist of intramuscular injections of betamethasone 12 mg two doses 24 hours apart and dexamethasone in either two doses of 12 mg 24 hours apart or four doses of 6 mg every 12 hours. Therefore, the course’s complete administration takes at least 24 hours. However, many times, preterm delivery is imminent and cannot be delayed for the completion of steroids. An observational study from Australia reported that 45% of pregnant women referred to tertiary hospitals …