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. 2026 Feb 16:fetalneonatal-2025-328872.
doi: 10.1136/archdischild-2025-328872. Online ahead of print.

Term neonatal admissions for hypoglycaemia in England and Wales, 2012-2020: a population-based study using the National Neonatal Research Database

Behrouz Nezafat Maldonado  1   2 , Frances Conti-Ramsden  3 , Tim J van Hasselt  4 , Jessica Fleminger  5 , Lucy C Chappell  5 , Cheryl Battersby  6   2 ; UK Neonatal Collaborative
Affiliations

Term neonatal admissions for hypoglycaemia in England and Wales, 2012-2020: a population-based study using the National Neonatal Research Database

Behrouz Nezafat Maldonado et al. Arch Dis Child Fetal Neonatal Ed. .

Abstract

Objective: To evaluate the impact of a change in national guidance on the management of hypoglycaemia on UK term neonatal unit (NNU) admissions, describe perinatal risk factors for hypoglycaemia and identify opportunities to reduce term infant hypoglycaemia admissions.

Design: Retrospective observational cohort study, the UK National Neonatal Research Database.

Patients: Term infant NNU admissions in England and Wales, 2012-2020.

Main outcome measures: Term admission rate to NNU primarily for hypoglycaemia/1000 term live births. Change between epoch 1 (36 months before the publication of the British Association of Perinatal Medicine (BAPM) Framework in April 2017) and epoch 2 (36 months after the publication of the BAPM Framework in April 2017).

Results: Term admissions primarily for hypoglycaemia decreased from 4.9 (95% CI 4.8 to 5.1) to 3.3 (95% CI 3.1 to 3.4) admissions/1000 term live births; proportion of potentially avoidable hypoglycaemia admissions (enteral feeds and special care only) decreased (from 12.8% (95% CI 12.1% to 13.4%) to 8.9% (95% CI 8.3% to 9.5%)), time to NNU admission and median length of stay were unchanged between epoch 1 and epoch 2. 46.5% (11 825/25 406) of infants admitted primarily for hypoglycaemia had one or more BAPM hypoglycaemia risk factors. Of infants with hypoglycaemia without BAPM risk factors, 44% (5990/13 581) had a birth weight above the 90th centile or between the 2nd centile and the 9.9th centile.

Conclusions: The publication of a national framework for term hypoglycaemia management was associated with a reduction in term NNU admission rates without delays in admission time or increased length of stay. One in two infants admitted for hypoglycaemia had no BAPM risk factors. Future research should explore birth weight between the 2nd centile and the 9.9th centile and above the 90th centile as additional factors that may further enhance hypoglycaemia risk stratification.

Keywords: Health services research; Intensive Care Units, Neonatal; Neonatology.

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Conflict of interest statement

Competing interests: FC-R receives salary as Chief Medical Officer at MEGI Health UK Ltd, holds equity in Nexus Connected Limited where they serve as an advisor, and receives consulting fees for advisory services provided through Option 5 Health Limited, Revena Limited and Gerson Lehrman Group Limited (GLG). The remaining authors report no conflicts of interest.

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