NEWTT2 FAQs: Glucose
Frequently asked questions about the NEWTT2 framework and chart.
Which newborns warrant a glucose measurement?
Glucose measurements are indicated in those newborns who fall within the BAPM hypoglycaemia framework at risk groups including for a newborn whose feeding deteriorates or who is feeding poorly (see main framework Table 2 and appendix 1: at risk groups); glucose measurement is not indicated in every newborn requiring NEWTT2 observations.
How should I calculate the birth weight centile to determine qualification for an at risk newborn for hypoglycaemia?
The birth weight centile should be calculated using the BAPM hypoglycaemia framework for practice which refers to the NEWTT 2015 framework.
When should glucose be measured in the hypoglycaemia at risk group?
Using the guidance notes (appendix 2) for NEWTT2 chart completion glucose is only measured at the times given in the BAPM hypoglycaemia framework for practice; glucose is not required at every set of NEWTT2 observations for this at risk group.
Does the NEWTT2 Framework align with the 2023 update for the BAPM hypoglycaemia framework?
The measurement ranges chosen align with the BAPM hypoglycaemia framework for practice which recommends intervention to raise glucose in the following situations:
- Value of <1.0 at any time
- Baby with abnormal clinical signs: single value <2.5mmol/L
- Baby at risk of impaired metabolic adaptation but without abnormal clinical signs: <2.0mmol/l and measuring <2.0 mmol/l at next measurement.
A glucose value in the purple zone <1mmol/L at any time with or without other scoring observations is abnormal and warrants immediate escalation as this newborn is at risk.
A glucose value within the pink/red zone 1.0-1.9mmol/L warrants a score of 2 even if all other observations in the set of NEWTT2 are normal and score zero (total NEWTT2 score of 2); this prompts the maternity team to escalate as this newborn requires an intervention e.g., glucose-gel and feeding support.
A glucose value in the yellow/amber zone 2.0-2.5mmol/L without other NEWTT2 abnormal signs scores 1.
Why is a glucose level 2.0-2.5mmol/L in the yellow/amber zone and warrant a score of 1 when it is considered normal in term babies?
There are two reasons we have allocated a score of 1 to glucose level 2.0-2.5mmol/L:
1) A score of 1 will trigger a repeat set of observations within the hour, which aligns with the BAPM hypoglycaemia framework. A repeat glucose measurement is indicated only if recommended by the hypoglycaemia guidance.
2) A value of <2.5mmol/L with abnormal clinical signs warrants intervention according to BAPM hypoglycaemia framework. Therefore, by allocating a score of 1 to a glucose level 2.0-2.5mmol, this will result in an overall score of 2 or more in a baby with abnormal clinical signs who scores 1 or more in other sections of NEWTT2, and will trigger escalation and review.
