title: Two hour blood glucose levels in at-risk babies: An audit of Canadian guidelines.
abstract: BACKGROUND
  The Canadian guidelines recommend blood glucose (BG) screening starting at 2 h of age in asymptomatic 'at-risk' babies (including small-for-gestational-age [SGA] and large-for-gestational-age [LGA] infants), with intervention cut-offs of 1.8 mmol/L and 2.6 mmol/L. The present study reviews and audits this practice in full-term newborn populations.
  
  
  METHODS
  A literature review meta-analyzed BG values in appropriate-for-gestational age (AGA) term newborns to establish normal 1 h, 2 h and 3 h values. A clinical review audited screening of 'at-risk' SGA and LGA term newborns, evaluating both clinical burden and validity.
  
  
  RESULTS
  The review included six studies, although none clearly defined the plasma glucose standard. The pooled mean (plasma) BG level in AGA babies 2 h of age was 3.35 mmol/L (SD=0.77), significantly higher than 1 h levels (3.01 mmol/L, SD=0.96). In the audit, 78 SGA and 142 LGA babies each had an average of 6.0 and 4.7 BG tests, respectively. The mean 2 h BG levels for SGA (3.42 mmol/L, SD=1.02) and LGA (3.31 mmol/L, SD=0.66) babies did not differ significantly from the AGA pooled mean. Receiver operating characteristic curves showed that 2 h BG levels in LGA and SGA babies predicted later hypoglycemia (defined as a BG level lower than 2.6 mmol/L), but sensitivities and specificities were poor.
  
  
  CONCLUSIONS
  Published 2 h BG levels for AGA babies are higher than 1 h values and are similar to audited 2 h levels in SGA and LGA babies. Clinically, 2 h levels are predictive of later hypoglycemia but may require repeat BG testing. Audit is an important tool to validate national guidelines, to minimize their burden and to maximize their utility.
authors.affiliation: Discipline of Pediatrics (Neonatology), Memorial University, Eastern Health, St John's, Newfoundland and Labrador.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Croke
authors.forename: Meagan
authors.initials: M
authors.lastname: Sullivan
authors.forename: Anne
authors.initials: A
authors.lastname: Ryan-Drover
authors.forename: Ed
authors.initials: E
authors.lastname: Randell
authors.forename: Wayne
authors.initials: W
authors.lastname: Andrews
authors.forename: Khalid
authors.initials: K
authors.lastname: Aziz