114 - Utility of Routine Glucose Screening in Well Newborns > 41 Weeks: Evaluating a Gap in Risk-Based Screening

Publication Number: 2109.114

Sangeetha Athis Rajh, Baylor College of Medicine, Sugar Land, TX, United States; Cecilia Torres Day, Baylor College of Medicine, Sugar Land, TX, United States; Olivia Lennon, Texas A&M Health Science Center College of Medicine, Houston, TX, United States; Athis Arunachalam, Baylor College of Medicine, Houston, TX, United States; Aderonke Adefisayo, Baylor College of Medicine, Houston, TX, United States

Background: Risk-based neonatal hypoglycemia screening relies on classifying infants as small or large for gestational age. The Olsen chart provides data only through 41 weeks, while Fenton, INTERGROWTH-21st, and WHO charts are derived from preterm or international populations. Few datasets extend beyond 41 weeks and lack corresponding length and head circumference data, making them impractical for clinical use. Given this gap, our nursery adopted universal glucose screening for well newborns ≥ 41 weeks

Objective: To determine the incidence of hypoglycemia, treatment needs, and screening workload among well newborns ≥ 41 weeks, and to evaluate whether traditional perinatal risk factors are associated with hypoglycemia in this group

Design/Methods: Single-center retrospective cohort (Jan 2023–Oct 2025) of singleton, well-appearing infants 41 + 0 to 41 + 6 weeks. Exclusions: major anomalies, 5-min Apgar < 7, NICU admission for non-hypoglycemia reasons, and infants of diabetic mothers. Nursery thresholds were < 40 mg/dL (0–4 h) and < 45 mg/dL (4–24 h). Data included glucose results, number of checks, dextrose gel/IV therapy, NICU transfer, and perinatal variables (feeding, temperature, Apgar, delivery mode, maternal HTN)

Results: Of 289 infants, 233 (81 %) had ≥ 1 glucose check. Median birth weight was 3600 g (IQR 3310–3910), length 52.7 cm (51.0–53.3), and head circumference 34.5 cm (33.5–35.5). Low Apgar < 7 in 3.8 % (1 min) and 0.35 % (5 min); hypothermia < 97.7 °F in 4.8 %.
Hypoglycemia occurred in 8.2 % (95 % CI 5.3–12.4); severe in 0.4 % (95 % CI 0.1–2.4). Dextrose gel 7.7 % (95 % CI 4.9–11.9); IV dextrose 1.3 % (95 % CI 0.4–3.7); NICU transfer 1.7 % (95 % CI 0.7–4.3). Median nadir 57 mg/dL (IQR 49–62); median 3 checks (IQR 3–3). Feeding delay > 60 min, feeding type, delivery mode, low Apgar, temperature, and maternal comorbidities were not significantly associated with hypoglycemia (p > 0.05). No adverse events occurred

Conclusion(s): In well newborns ≥ 41 weeks, routine screening identified infrequent hypoglycemia and minimal need for intervention. Hypoglycemia occurred less frequently in this cohort compared to reports where higher incidence rates (≈ 19%) are commonly seen in risk-based screening of well-term infants at a < 45 mg/dL threshold. Universal screening remains a pragmatic workaround given the lack of validated U.S. growth references beyond 41 weeks, but its limited yield supports refining late-term risk criteria and developing comprehensive electronic references to enable consistent, risk-based care