D10W:
6 mL/kg/h for first 10 kg
+ 3 mL/kg/h for 11–20 kg
+ 1.5 mL/kg/h for each additional kg >20 kg
Consider diluting the D25 or D50 bolus, with NS 1-to-1, as those concentrations may be sclerosing to veins
Recheck 5 minutes after dose and repeat dose if low.
Consider glucagon IM/SQ if IV access is not readily available
Glucometer reading 20-40mg/dL, infant is term and is able to feed:
Draw blood for stat blood glucose.
Feed 5 mL/kg of D5W.
Repeat blood glucose or Glucometer 20 min after feeding.
Glucometer reading:
<20mg/dL or
<40mg/dL and NPO or preterm or
<40mg/dL after feeding or
<40mg/dL and symptomatic
Draw blood for stat glucose measurement.
Give IV bolus of 2-3 mL/kg of D10W.
Begin continuous infusion of D10W at 4-6mg/kg/min.
If infant of diabetic mother, begin D10W at 8-10mg/kg/min (100-125 cc/kg/d).
Repeat blood glucose in 20 min and pursue treatment until blood sugar >40mg/dL.
For persistent<unk>  despite above measures:
Increase rate of glucose infusion stepwise in 2mg/kg/min*increments up to 12-15mg/kg/min glucose. Use increased volume with caution in infants where volume overload is a concern. Maximal concentration of glucose in peripheral IV is D12.5.
If infant requires IV dextrose concentrations >12.5%, insert central venous catheter.
Do not use D25W or D50W IV or large IV volume boluses as this creates rebound<unk>  in infants who are hyperinsulinemic. In addition, administration of D25W or D50W can cause dangerous increase in plasma osmolarity.
If<unk>  is not controlled with above measures:
Obtain Endocrine Consult to guide further diagnostic evaluation and management.
While awaiting consult, send blood (while blood sugar is low) for glucose, plasma cortisol, growth hormone and insulin concentrations
Further management may include glucocorticoids, diazoxide, somatostatin or pancreatectomy.
Draw blood for stat blood glucose.
Feed 5 mL/kg of D5W.
Repeat blood glucose or Glucometer 20 min after feeding.
<20mg/dL or
<40mg/dL and NPO or preterm or
<40mg/dL after feeding or
<40mg/dL and symptomatic
Draw blood for stat glucose measurement.
Give IV bolus of 2-3 mL/kg of D10W.
Begin continuous infusion of D10W at 4-6mg/kg/min.
If infant of diabetic mother, begin D10W at 8-10mg/kg/min (100-125 cc/kg/d).
Repeat blood glucose in 20 min and pursue treatment until blood sugar >40mg/dL.
Draw blood for stat glucose measurement.
Give IV bolus of 2-3 mL/kg of D10W.
Begin continuous infusion of D10W at 4-6mg/kg/min.
If infant of diabetic mother, begin D10W at 8-10mg/kg/min (100-125 cc/kg/d).
Repeat blood glucose in 20 min and pursue treatment until blood sugar >40mg/dL.
Increase rate of glucose infusion stepwise in 2mg/kg/min*increments up to 12-15mg/kg/min glucose. Use increased volume with caution in infants where volume overload is a concern. Maximal concentration of glucose in peripheral IV is D12.5.
If infant requires IV dextrose concentrations >12.5%, insert central venous catheter.
Do not use D25W or D50W IV or large IV volume boluses as this creates rebound<unk>  in infants who are hyperinsulinemic. In addition, administration of D25W or D50W can cause dangerous increase in plasma osmolarity.
Obtain Endocrine Consult to guide further diagnostic evaluation and management.
While awaiting consult, send blood (while blood sugar is low) for glucose, plasma cortisol, growth hormone and insulin concentrations
Further management may include glucocorticoids, diazoxide, somatostatin or pancreatectomy.
Use either of the following formulas:
(% glucose x mL/kg/d)/144 = glucose infusion rate (mg/kg/min)
(% glucose x mL/h)/(6 x body weight in kg) = glucose infusion rate (mg/kg/min)
Check insulin, c-peptide, GH, cortisol, beta hydroxybutyrate, UA
Increase volume by 30cc/kg/d
Increase glucose to 12.5%
If continues for >3 d: consult endocrinology, or sooner
Neonatal hypoglycemia
Decreased substrate availability
Non-neonatal hypoglycemia 
Intra-uterine growth retardation
Neonatal jaundice
Glycogen storage disease
Neonatal abstinence syndrome
Inborn errors of metabolism 