基层医疗卫生机构常见新生儿疾病诊疗专家共识:新生儿低血糖症(2025年)

中华医学会儿科学分会新生儿学组, 《中国当代儿科杂志》编辑委员会

中国当代儿科杂志 ›› 2025, Vol. 27 ›› Issue (11) : 1301-1309.

PDF(677 KB)
HTML
PDF(677 KB)
HTML
中国当代儿科杂志 ›› 2025, Vol. 27 ›› Issue (11) : 1301-1309. DOI: 10.7499/j.issn.1008-8830.2503049
标准·方案·指南

基层医疗卫生机构常见新生儿疾病诊疗专家共识:新生儿低血糖症(2025年)

作者信息 +

Expert consensus on the diagnosis and treatment of common neonatal diseases in primary healthcare institutions: neonatal hypoglycemia (2025)

Author information +
文章历史 +

摘要

为有效帮助基层医护工作者及时识别新生儿低血糖症,尽快给予有效治疗,从而减少低血糖脑病的发生,中华医学会儿科学分会新生儿学组牵头,组织专家整合新生儿低血糖症临床研究进展,通过充分讨论,制定了《基层医疗卫生机构常见新生儿疾病诊疗专家共识:新生儿低血糖症(2025年)》,针对基层医护人员对于新生儿低血糖症的9个常见临床问题,形成了14条推荐意见。

Abstract

To help primary healthcare providers promptly identify and effectively treat neonatal hypoglycemia, thereby reducing the risk of hypoglycemic encephalopathy, the Subspecialty Group of Neonatology, Society of Pediatrics, Chinese Medical Association led the development of this expert consensus. Through thorough discussion, experts integrated recent clinical advances to formulate the "Expert consensus on the diagnosis and treatment of common neonatal diseases in primary healthcare institutions: neonatal hypoglycemia (2025)". This consensus addresses 9 common clinical questions and provides 14 recommendations.

关键词

低血糖症 / 共识 / 诊断 / 治疗 / 基层医疗卫生机构 / 新生儿

Key words

Hypoglycemia / Consensus / Diagnosis / Treatment / Primary healthcare institution / Neonate

引用本文

导出引用
中华医学会儿科学分会新生儿学组, 《中国当代儿科杂志》编辑委员会. 基层医疗卫生机构常见新生儿疾病诊疗专家共识:新生儿低血糖症(2025年)[J]. 中国当代儿科杂志. 2025, 27(11): 1301-1309 https://doi.org/10.7499/j.issn.1008-8830.2503049
Subspecialty Group of Neonatology, Society of Pediatrics, Chinese Medical Association, Editorial Board of Chinese Journal of Contemporary Pediatrics. Expert consensus on the diagnosis and treatment of common neonatal diseases in primary healthcare institutions: neonatal hypoglycemia (2025)[J]. Chinese Journal of Contemporary Pediatrics. 2025, 27(11): 1301-1309 https://doi.org/10.7499/j.issn.1008-8830.2503049

参考文献

[1]
Roeper M, Hoermann H, Kummer S, et al. Neonatal hypoglycemia: lack of evidence for a safe management[J]. Front Endocrinol (Lausanne), 2023, 14: 1179102. PMCID: PMC 10285477. DOI: 10.3389/fendo.2023.1179102 .
[2]
Adamkin DH. Low blood sugar levels in the newborn infant: do changing goal posts matter?[J]. Semin Fetal Neonatal Med, 2021, 26(3): 101202. DOI: 10. 1016/j.siny.2021.101202 .
[3]
Harris DL, Weston PJ, Harding JE. Incidence of neonatal hypoglycemia in babies identified as at risk[J]. J Pediatr, 2012, 161(5): 787-791. DOI: 10. 1016/j.jpeds.2012.05.022 .
[4]
Balshem H, Helfand M, Schünemann HJ, 等. GRADE指南:Ⅲ.证据质量分级[J]. 中国循证医学杂志, 2011, 11(4): 451-455. DOI: 10.3969/j.issn.1672-2531.2011.04.017 .
[5]
Zeng L, Brignardello-Petersen R, Hultcrantz M, et al. GRADE guidelines 32: GRADE offers guidance on choosing targets of GRADE certainty of evidence ratings[J].J Clin Epidemiol, 2021, 137: 163-175. DOI: 10. 1016/j.jclinepi.2021.03.026 .
[6]
Bateman BT, Patorno E, Desai RJ, et al. Late pregnancy β blocker exposure and risks of neonatal hypoglycemia and bradycardia[J]. Pediatrics, 2016, 138(3): e20160731. PMCID: PMC5005024. DOI: 10. 1542/peds.2016-0731 .
[7]
Arimitsu T, Kasuga Y, Ikenoue S, et al. Risk factors of neonatal hypoglycemia in neonates born to mothers with gestational diabetes[J]. Endocr J, 2023, 70(5): 511-517. DOI: 10. 1507/endocrj.EJ22-0521 .
[8]
McKinlay CJ, Alsweiler JM, Ansell JM, et al. Neonatal glycemia and neurodevelopmental outcomes at 2 years[J]. N Engl J Med, 2015, 373(16): 1507-1518. PMCID: PMC4646166. DOI: 10. 1056/NEJMoa1504909 .
[9]
Stark J, Simma B, Blassnig-Ezeh A. Incidence of hypoglycemia in newborn infants identified as at risk[J]. J Matern Fetal Neonatal Med, 2020, 33(18): 3091-3096. DOI: 10. 1080/14767058.2019.1568985 .
[10]
Lagacé M, Tam EWY. Neonatal dysglycemia: a review of dysglycemia in relation to brain health and neurodevelopmental outcomes[J]. Pediatr Res, 2024, 96(6): 1429-1437. DOI: 10. 1038/s41390-024-03411-0 .
[11]
Lucas A, Morley R, Cole TJ. Adverse neurodevelopmental outcome of moderate neonatal hypoglycaemia[J]. BMJ, 1988, 297(6659): 1304-1308. PMCID: PMC 1834933. DOI: 10. 1136/bmj.297.6659.1304 .
[12]
Shah R, Harding J, Brown J, et al. Neonatal glycaemia and neurodevelopmental outcomes: a systematic review and meta-analysis[J]. Neonatology, 2019, 115(2): 116-126. DOI: 10. 1159/000492859 .
[13]
Dixon KC, Ferris RL, Marikar D, et al. Definition and monitoring of neonatal hypoglycaemia: a nationwide survey of NHS England Neonatal Units[J]. Arch Dis Child Fetal Neonatal Ed, 2017, 102(1): F92-F93. DOI: 10.1136/archdischild-2016-311473 .
[14]
Khalaf M. Guidelines for the management of neonatal hypoglycemia[EB/OL]. [2024-06-19].
[15]
Queensland Clinical Guidelines Steering Committee. Statewide Maternity and Neonatal Clinical Network(Queensland) [EB/OL]. [2024-06-11].
[16]
中华医学会儿科学分会新生儿学组. 新生儿低血糖临床规范管理专家共识(2021)[J]. 中国当代儿科杂志, 2022, 24(1): 1- 13. PMCID: PMC8802387. DOI: 10.7499/j.issn.1008-8830.2108061 .
[17]
封志纯, 段江, 张传仓. 新生儿低血糖的诊断和治疗[J]. 实用儿科临床杂志, 2010, 25(14): 1042-1045.
[18]
Hawdon JM. Identification and management of neonatal hypoglycemia in the full-term infant. British Association of Perinatal Medicine Framework for Practice, 2017[J]. J Hum Lact, 2019, 35(3): 521-523. DOI: 10. 1177/0890334419846128 .
[19]
Mitanchez D, Hellström-Westas L, Zimmermann LJI, et al. Hypoglycaemia in at risk term infants[EB/OL].[2025-02-15].
[20]
Narvey MR, Marks SD. The screening and management of newborns at risk for low blood glucose[J]. Paediatr Child Health, 2019, 24(8): 536-554. PMCID: PMC6901164. DOI: 10. 1093/pch/pxz134 .
[21]
Davidkova S, Crone S. Neonatal hypoglycaemia: screening and management[EB/OL]. [2025-02-15].
[22]
Wight NE; Academy of Breastfeeding Medicine. ABM clinical protocol 1: guidelines for glucose monitoring and treatment of hypoglycemia in term and late preterm neonates, revised 2021 [J]. Breastfeed Med, 2021, 16(5): 353-365. DOI: 10. 1089/bfm.2021.29178.new .
[23]
Thornton PS, Stanley CA, De Leon DD, et al. Recommendations from the Pediatric Endocrine Society for evaluation and management of persistent hypoglycemia in neonates, infants, and children[J]. J Pediatr, 2015, 167(2): 238-245. PMCID: PMC 11891912. DOI: 10. 1016/j.jpeds.2015.03.057 .
[24]
Alkalay AL, Sarnat HB, Flores-Sarnat L, et al. Population meta- analysis of low plasma glucose thresholds in full-term normal newborns[J]. Am J Perinatol, 2006, 23(2): 115-119. DOI: 10. 1055/s-2006-931912 .
[25]
van Kempen AAMW, Eskes PF, Nuytemans DHGM, et al. Lower versus traditional treatment threshold for neonatal hypoglycemia[J]. N Engl J Med, 2020, 382(6): 534-544. DOI: 10. 1056/NEJMoa1905593 .
[26]
McKinlay CJD, Alsweiler JM, Anstice NS, et al. Association of neonatal glycemia with neurodevelopmental outcomes at 4.5 years[J]. JAMA Pediatr, 2017, 171(10): 972-983. PMCID: PMC5710616. DOI: 10.1001/jamapediatrics.2017.1579 .
[27]
Mahajan G, Mukhopadhyay K, Attri S, et al. Neurodevelopmental outcome of asymptomatic hypoglycemia compared with symptomatic hypoglycemia and euglycemia in high-risk neonates[J]. Pediatr Neurol, 2017, 74: 74-79. DOI: 10.1016/j.pediatrneurol.2017.05.028 .
[28]
Kaiser JR, Bai S, Gibson N, et al. Association between transient newborn hypoglycemia and fourth-grade achievement test proficiency: a population-based study[J]. JAMA Pediatr, 2015, 169(10): 913-921. DOI: 10. 1001/jamapediatrics.2015.1631 .
[29]
Wickström R, Skiöld B, Petersson G, et al. Moderate neonatal hypoglycemia and adverse neurological development at 2-6 years of age[J]. Eur J Epidemiol, 2018, 33(10): 1011-1020. PMCID: PMC6153551. DOI: 10. 1007/s10654-018-0425-5 .
[30]
中华医学会儿科学分会内分泌遗传代谢学组, 中华儿科杂志编辑委员会. 先天性高胰岛素血症性低血糖诊治专家共识(2022)[J]. 中华儿科杂志, 2023, 61(5): 412-417. DOI: 10.3760/cma.j.cn 112140-20221031-00924 .
[31]
Burakevych N, McKinlay CJD, Harris DL, et al. Factors influencing glycaemic stability after neonatal hypoglycaemia and relationship to neurodevelopmental outcome[J]. Sci Rep, 2019, 9(1): 8132. PMCID: PMC6544629. DOI: 10.1038/s41598-019-44609-1 .
[32]
庄斌, 林新祝. 新生儿低血糖脑病研究进展[J]. 中华新生儿科杂志(中英文), 2019, 34(5): 398-400. DOI: 10.3760/cma.j.issn.2096-2932.2019.05.020 .
[33]
毛健, 陈丽英, 富建华, 等. 新生儿低血糖脑损伤临床特征与磁共振成像动态变化[J]. 中国当代儿科杂志, 2008, 10(2): 115- 120.
[34]
邵肖梅, 叶鸿瑁, 丘小汕. 实用新生儿学[M]. 5版. 北京: 人民卫生出版社, 2019.
[35]
Rasmussen AH, Wehberg S, Pørtner F, et al. Neurodevelopmental outcomes after moderate to severe neonatal hypoglycemia[J]. Eur J Pediatr, 2020, 179(12): 1981-1991. PMCID: PMC7666672. DOI: 10. 1007/s00431-020-03729-x .
[36]
Nivins S, Kennedy E, Thompson B, et al. Associations between neonatal hypoglycaemia and brain volumes, cortical thickness and white matter microstructure in mid-childhood: an MRI study [J]. Neuroimage Clin, 2022, 33: 102943. PMCID: PMC8856905. DOI: 10.1016/j.nicl.2022.102943 .
[37]
Ma JH, Kim YJ, Yoo WJ, et al. MR imaging of hypoglycemic encephalopathy: lesion distribution and prognosis prediction by diffusion-weighted imaging[J]. Neuroradiology, 2009, 51(10): 641-649. DOI: 10.1007/s00234-009-0544-5 .
[38]
王永姣, 刘锟, 叶信健, 等. 新生儿低血糖脑病的典型与非典型MRI特征[J]. 中华医学杂志, 2014, 94(37): 2938-2940. DOI: 10.3760/cma.j.issn.0376-2491.2014.37.013 .
[39]
Zhang Y, Chen D, Ji Y, et al. Dynamic magnetic resonance imaging findings in the early stages of neonatal hypoglycemic brain injury[J]. Eur J Pediatr, 2022, 181(12): 4167-4174. DOI: 10.1007/s00431-022-04637-y .
[40]
Dönmez FY, Arslan S, Agildere AM, et al. Value of diffusion- weighted imaging in hypoglycemic encephalopathy[J]. Neurosciences (Riyadh), 2015, 20(3): 296-297. PMCID: PMC4710337. DOI: 10.17712/nsj.2015.3.20140696 .
[41]
Harris DL, Weston PJ, Williams CE, et al. Cot-side electroencephalography monitoring is not clinically useful in the detection of mild neonatal hypoglycemia[J]. J Pediatr, 2011, 159(5): 755-760.e1. DOI: 10.1016/j.jpeds.2011.04.026 .
[42]
Pinchefsky EF, Hahn CD, Kamino D, et al. Hyperglycemia and glucose variability are associated with worse brain function and seizures in neonatal encephalopathy: a prospective cohort study[J]. J Pediatr, 2019, 209: 23-32. DOI: 10.1016/j.jpeds.2019.02.027 .
[43]
唐振, 欧阳志翠, 胡呐, 等. 足月新生儿不同血糖水平振幅整合脑电图特征[J]. 中华新生儿科杂志(中英文), 2018, 33(6): 427-431. DOI: 10.3760/cma.j.issn.2096-2932.2018.06.007 .
[44]
Warren S, Midodzi WK, Allwood Newhook LA, et al. Effects of delayed newborn bathing on breastfeeding, hypothermia, and hypoglycemia[J]. J Obstet Gynecol Neonatal Nurs, 2020, 49(2): 181-189. DOI: 10.1016/j.jogn.2019.12.004 .
[45]
中华医学会围产医学分会, 中华医学会妇产科学分会产科学组, 中华护理学会产科护理专业委员会, 等. 中国新生儿早期基本保健技术专家共识(2020)[J]. 中华围产医学杂志, 2020, 23(7): 433-440. DOI: 10.3760/cma.j.cn 113903-20200416-00354 .
[46]
Chiruvolu A, Miklis KK, Stanzo KC, et al. Effects of skin-to-skin care on late preterm and term infants at-risk for neonatal hypoglycemia[J]. Pediatr Qual Saf, 2017, 2(4): e030. PMCID: PMC6132485. DOI: 10.1097/pq9.0000000000000030 .
[47]
Roberts LF, Harding JE, Crowther CA, et al. Early feeding for the prevention of neonatal hypoglycaemia: a systematic review and meta-analysis[J]. Neonatology, 2024, 121(2): 141-156. PMCID: PMC 10987277. DOI: 10.1159/000535503

脚注

工作组所有成员均填写了利益冲突声明表,经评价无成员存在利益冲突。

基金

国家重点研发计划“生育健康及妇女儿童健康保障”重点专项(2024YFC2707700)
新疆维吾尔自治区区域协同专项-科技援疆计划(2021E02065)

编委: 邓芳明

版权

版权所有 © 2023中国当代儿科杂志
PDF(677 KB)
HTML

Accesses

Citation

Detail

段落导航
相关文章

/