A Comparative Study of Blood Glucose Measurements Using Glucometer Readings and the Standard Method in the Diagnosis of Neonatal Hypoglycemia

Document Type : Original Article


1 Department of Pediatrics, Faculty of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran

2 Birjand Atherosclerosis and Coronary Artery Research Center, Birjand University of Medical Sciences, Birjand, Iran


Background: Hypoglycemia is one of the most common neonatal disorders, associated with severe complications. There has been a great deal of controversy regarding the definition and screening of hypoglycemia. Therefore, in this study, we aimed to determine a cut-off value for blood glucose level in glucometer readings.
Methods: This cross-sectional study was conducted on 238 newborns at risk of hypoglycemia, admitted to Baqiyatallah Hospital of Tehran, Iran in 2012; the subjects were selected via simple sampling. After obtaining informed consents from the newborns’ parents, 1 cc blood samples were sent to the laboratory for measuring the blood glucose level. Moreover, venous blood samples, as well as heel-stick blood samples, were obtained for glucometer measurements. Blood glucose measurements were used to determine the cut-off value by the receiver operating characteristic (ROC) curve and make comparisons with the diagnostic criteria for hypoglycemia in the literature.
Results: A total of 238 infants with the mean weight of 2869±821.9 g were enrolled in this study. The mean (±SD) blood glucose levels were 65.1±22.9, 82.9±24.7, and 84.4±24.8 mg/dl, based on the standard laboratory method, glucometer reading of venous blood samples, and glucometer reading of heel-stick capillary blood samples, respectively. The optimal cut-off point for hypoglycemia was determined as 65 mg/dl, using glucometer-based assessment of heel-stick blood samples.
Conclusion: The significant difference in blood glucose levels measured by the laboratory method and outpatient glucometer readings highlights the importance of a cut-off value for rapid assessment and control of blood glucose and timely detection of hypoglycemia. In fact, the cut-off value introduced in the present study could facilitate such measurements.


  1. Kliegman RM, Behrman RE, Jenson HB, Stanton BF. Nelson textbook of pediatrics. 20th ed. Philadelphia: Elsevier-Health Sciences Division; 2016. P. 773-5.
  2. Lucas A, Morley R, Cole TJ. Adverse neurodevelopmental outcome of moderate neonatal hypoglycaemia. BMJ. 1988; 297(6659):1304-8.
  3. Boluyt N, van Kempen A, Offringa M. Neurodevelopment after neonatal hypoglycemia: a systematic review and design of an optimal future study. Pediatrics. 2006; 117(6):2231-43.
  4. Cornblath M, Hawdon JM, Williams AF, Aynsley-Green A, Ward-Platt MP, Schwartz R, et al. Controversies regarding definition of neonatal hypoglycemia: suggested operational thresholds. Pediatrics. 2000; 105(5):1141-5.
  5. Marcdante K, Kliegman RM, Behrman RE, Jenson HB. Nelson essentials of pediatric. New York: Elsevier Health Sciences; 2010. P. 883-96.
  6. Hawdon JM, Ward Platt MP, Aynsley-Green A. Patterns of metabolic adaptation for preterm and term infants in the first neonatal week. Arch Dis Child. 1992; 67(4Spec No):357–65.
  7. Papp M, Sharief N. Comparison of two strip test methods of whole blood glucose measurement in the neonatal period. Acta Paediatr. 2001; 90(9):1042-6.
  8. Stanley CA, Baker L. The causes of neonatal hypoglycemia. N Engl J Med. 1999; 340(15):1200-1.
  9. Lubchenco LO, Bard H. Incidence of hypoglycemia in newborn infants classified by birth weight and gestational age. Pediatrics. 1971; 47(5):831-8.

10. Van Haltren K, Malhotra A. Characteristics of infants admitted with hypoglycemia to a neonatal unit. J Pediatr Endocrinol Metab. 2013; 26(5-6):525-9.

11. Committee on Fetus and Newborn, Adamkin DH. Postnatal glucose homeostasis in late-preterm and term infants. Pediatrics. 2011; 127(3):575-9.

12. Balion C, Grey V, Ismaila A, Blatz S, Seidlitz W. Screening for hypoglycemia at the bedside in the neonatal intensive care unit (NICU) with the Abbott PCx glucose meter. BMC pediatr. 2006; 6(1):28-38.

13. Rosenthal M, Ugele B, Lipowsky G, Kuster H. The Accutrend sensor glucose analyzer may not be adequate in bedside testing for neonatal hypoglycemia. Eur J Pediatr. 2006; 165(2):99-103.

14. Srinivasan G, Pildes RS, Cattamanchi G, Voora S, Lilien LD. Plasma glucose values in normal neonates: a new look. J Pediatr. 1986 Jul; 109(1):114-7.

15. Ho HT, Yeung WK, Young BW. Evaluation of "point of care" devices in the measurement of low blood glucose in neonatal practice. Arch Dis Child Fetal Neonatal Ed. 2004 Jul; 89(4):F356-9.

16. Ngerncham S, Piriyanimit S, Kolatat T, Wongsiridej P, Inchgarm L, Kitsommart R, et al. Validity of two point of care glucometers in the diagnosis of neonatal hypoglycemia. Indian Pediatr. 2012; 49(8):621-5.