• ethics
• neonatology
• pain

Cumberpatch et al 1 provide a fascinating and important insight into a unique study of blood glucose in healthy newborns. The Glucose in Well Babies (GLOW) study was designed to help understand what happens to glucose and related metabolites in newborn infants after birth. This is important, because there are a large number of newborns who have their blood sugar measured after birth. Clinicians need to know what a normal sugar level is, yet there is a lack of high-quality relevant evidence to guide that determination. This has contributed to striking differences in the recommendations from different bodies about what glucose level to aim for. There is a danger that some newborn infants are being overtreated (with risks of separation from parents, interference with breast feeding, and unnecessary medicalisation) or undertreated (with risks of hypoglycaemic brain injury).

One of the reasons for the lack of evidence is the problem that healthy newborn infants do not routinely have blood tests (apart from newborn screening at a couple of days of age). To work out what happens to blood sugar in normal newborns, you would have to perform clinically unnecessary blood sampling on multiple occasions over the first hours and days. Would any research ethics committee allow such a study to be performed? Would any parents of healthy newborn infants agree to their babies being in the study?

Ethical guidelines tend to be fairly restrictive of non-therapeutic research …