Hypoglycemia is a common cause of neonatal admission and is often managed with dextrose infusion albeit the early use of 40% glucose gel may have reduced admission rates. Our South Australian guideline recommends IV Dex 10% bolus and infusion at 90/kg/day if BGL is below 1.5 mmol/L, and also recommends iv Dex 10% at 60 ml/kg/day if sugars are between 1.5 and 2.5 despite enteral feeds of 30 mL/kg/day.

But what is the role for higher rates of enteral feeding on Day 1 in the otherwise well infant without significant respiratory distress? Breastfeeding and EBM where possible, but also either a term formula (~7.5 g carb/100mL) or preterm (8.3 g/100mL) with the additional option to add dextrose (eg 4 mL of 50% added to 100 mL of formula) or a dextrose polymer (poly-joule) which would allow even greater amounts to be added without excessive osmolality. How high can we go with these options, both in terms of concentration and volume?

Do any units use Dextrose 10% solutions enterally to manage the sugars without needing formula?

Theoretically we can max-out the gut glucose transporters even when there is no actual gut pathology - quoted max active absorption is 6 to 8 mg/kg/min only but I'm not sure how well-evidenced that is.

I'd like to get a sense of what other teams are doing to optimise enteral feed options in hypoglycemia so will try to post a very short survey.

20 years ago, normal lower values of glucose was 1,7 mmol for term and 1,1 for premature born, for those without symptoms.

I would like to know how we changed and what changed?

In our population we had a large number of LGA and IDMs that were challenging IV sticks. Late in my career we started placing og tubes with continuous formula feeds at 60-150 cc/kg/d with relatively good success. We thought a more continuous feed would not cause so much fluctuation in insulin production. Does anyone else do something similar?