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The report by Dr Nicholl on “normal blood glucose concentrations in healthy term newborns”1 raises the interesting and important question of how normoglycaemia in newborns can be defined. In a comprehensive review of the literature in 1997, an expert panel of the World Health Organization concluded that there are numerous approaches to defining normoglycaemia, including the statistical approach (which was taken by Dr Nicholl), the metabolic approach (what is the concentration of blood glucose at which normal cell homoeostasis is maintained?), the neurophysiological approach (below what concentration of blood glucose does impairment of neurological functions occur?), and, perhaps most importantly, the neurodevelopmental approach (does a relation exist between neonatal blood glucose concentrations and the neurodevelopmental outcome of children years later?).2 These different approaches towards definition of normoglycaemia contribute to the controversy that surrounds this issue.2,3 Other factors that influence newborn blood glucose concentrations, even in healthy term newborns, are perinatal complications,4 mode of delivery,5 and feeding behaviour.6 It appears therefore that there is very little solid evidence on which judgment of neonatal blood glucose concentrations can be based. Follow up studies looking at neurodevelopmental outcome of neonatal “hypoglycaemia” (and its treatment) in healthy term infants of various delivery modes and birth weights are urgently needed.
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