TOPLINE:

The implementation of the British Association of Perinatal Medicine (BAPM) hypoglycaemia management framework reduced term neonatal unit admissions for hypoglycaemia by one third without increasing short-term adverse events. Notably, more than half of the admitted infants for hypoglycaemia had no BAPM framework-defined risk factors.

METHODOLOGY:

• Researchers conducted a retrospective observational cohort study using data from the UK National Neonatal Research Database to evaluate changes in term neonatal unit admissions for hypoglycaemia and short-term adverse events before and after the publication of the BAPM hypoglycaemia management framework.
• They included 284,646 term infants admitted to neonatal units in England and Wales between January 2012 and December 2020. The analysis compared admission rates and outcomes across two 36-month epochs: pre-framework (April 2014 to March 2017) and post-framework (May 2017 to April 2020).
• The primary outcome was the admission rate of term infants to the neonatal unit for hypoglycaemia per 1000 term live births.
• Secondary outcomes included the admission time from birth, length of stay, short-term adverse events (seizures, severe brain injury, and mortality), and avoidable admissions (requiring only enteral feeds).
• Risk factors were defined as per the BAPM management framework (maternal diabetes, foetal growth restriction, and maternal beta-blocker use).

TAKEAWAY:

• The mean annual admission rate of term infants with hypoglycaemia decreased from 4.9 (95% CI, 4.8-5.1) to 3.3 (95% CI, 3.1-3.4) per 1000 term live births post-framework.
• No increase in seizures, severe brain injury, or mortality was observed; the proportion of potentially avoidable admissions declined from 12.8% to 8.9%.
• Over half of all term infants (53.5%) admitted for hypoglycaemia had no BAPM framework-defined risk factors; among these, 29% were small for gestational age (birth weight, 2nd-9.9th centile), and 15% were large for gestational age (birth weight > 90th centile).

IN PRACTICE:

"Our finding that 29% of all infants admitted for primary hypoglycaemia without BAPM risk factors are born with a birth weight on the 2nd centile to the 9.9th centile and 15% are born LGA [large for gestational age] (birth weight > 90th centile) supports the need for future research to evaluate the potential impact of these additional risk factors on term NNU [neonatal unit] hypoglycaemia admissions and maternity workload. Targeted screening of these groups may facilitate earlier intervention and contribute to a reduction in neonatal admissions," the authors wrote.

SOURCE:

This study was led by Behrouz Nezafat Maldonado, Imperial College London, and Frances Conti-Ramsden, King's College London, both in London, England. It was published online on December 03, 2025, in Archives of Disease in Childhood - Fetal and Neonatal Edition.

LIMITATIONS:

The primary reason for admission may be inaccurate as data were recorded for clinical use rather than research. As data on maternal medications and beta-blocker use were unavailable, maternal hypertension was used as a proxy risk factor for beta-blocker exposure. National data on mothers and infants with relevant risk factors outside neonatal units were also unavailable.

DISCLOSURES:

This study was funded through the Imperial National Institute for Health and Care Research Biomedical Research Centre. One author reported receiving salary as a chief medical officer at MEGI Health UK Ltd, holding equity and serving as an advisor at Nexus Connected Limited, and receiving consulting fees from Option 5 Health Limited, Revena Limited, and Gerson Lehrman Group Limited.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.