title: Standards of admission capillary blood glucose levels in cesarean born neonates.
abstract: BACKGROUND
  Neonatal hypoglycemia (NH) and cutoffs remain undefined. Our center screens all cesarean-delivered (CD) neonates for NH. We sought to define standards of admission capillary blood glucose levels (ACBGLs) in CD neonates who were at the lowest risk for hypoglycemia.
  
  
  METHODS
  Of 4947 neonates, 519 met all 14 inclusion criteria. These highly-selected neonates were apparently the healthiest, least-stressed, earliest to be admitted to nursery and at lowest-risk for hypoglycemia. For each CD, cord blood gases and glucose were determined and each infant was screened for blood glucose at nursery admission.
  
  
  RESULTS
  Sampling age was 41.6±15.3 minutes, a mean ACBGL of 52.3±10.7 mg/dL, and percentiles as follows: 1st percentile, 29.2; 3rd, 33.6; 5th, 35.0; 10th, 39.0; 25th, 46.0; 50th, 51.0; 75th, 58.0; 90th, 67.0; 95th, 71.0; 97th, 73.0, and 99th, 84.4. ACBGL rose significantly with increasing gestational age (P=0.004), increasing cord blood glucose (P<0.001), decreasing cord blood pH (P<0.001) and decreasing sampling age (P=0.027).
  
  
  CONCLUSIONS
  Setting uniform ACBGL cutoffs for NH definition is unachievable due to the enormous heterogeneity among newborns. Hence, we provide group-based ACBGL standards in CD neonates. We propose setting ACBGL cutoffs for use in CD neonates: 1) hypoglycemia: ACBGL <5th percentile (<35 mg/dL); and 2) interventional hypoglycemia: ACBGL <1st percentile (<30 mg/dL).
authors.affiliation: Department of Neonatology, Ruth Rappaport Children's Hospital, Haifa Israel, Rambam Health Care Campus, Bat-Galim, Haifa, 31096, Israel.|The Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
authors.forename: Tatiana
authors.initials: T
authors.lastname: Smolkin
authors.affiliation: Department of Neonatology, Ruth Rappaport Children's Hospital, Haifa Israel, Rambam Health Care Campus, Bat-Galim, Haifa, 31096, Israel.|The Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
authors.forename: Irena
authors.initials: I
authors.lastname: Ulanovsky
authors.affiliation: Department of Neonatology, Ruth Rappaport Children's Hospital, Haifa Israel, Rambam Health Care Campus, Bat-Galim, Haifa, 31096, Israel.
authors.forename: Pnina
authors.initials: P
authors.lastname: Carasso
authors.affiliation: Department of Neonatology, Ruth Rappaport Children's Hospital, Haifa Israel, Rambam Health Care Campus, Bat-Galim, Haifa, 31096, Israel. makhoul@rambam.health.gov.il.|The Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. makhoul@rambam.health.gov.il.
authors.forename: Imad R
authors.initials: IR
authors.lastname: Makhoul
mesh_terms: D001786:Blood Glucose / Q000032:analysis*; D002196:Capillaries; D002585:Cesarean Section; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000097:blood* / Q000175:diagnosis*; D007231:Infant, Newborn; D008297:Male; D015997:Neonatal Screening; D010343:Patient Admission; D012016:Reference Values; D012189:Retrospective Studies
chemical_list: D001786:Blood Glucose
keywords: capillary blood; cesarean delivery; glucose; hypoglycemia; newborn infant