INCIDENCE OF HYPOGLYCEMIA IN NEWBORN INFANTS

CLASSIFIED BY BIRTH WEIGHT AND GESTATIONAL AGE

Lula 0. Lubchenco, M.D., and Harry Bard, M.D.

From the Newborn and Premature Center, Division of Perinatal Medicine,

University of Colorado Medical Center, Denver, Colorado

ABSTRACT. The incidence of hypoglycemia was glycemia, the incidence in the preterm SCA groups
determined in newborn infants in a general obstet- was least reduced, i.e., to 40 and 21% respectively.
ric service. Except for IDM’s, evidence of intra-uterine
A random sample of patients was
studied from growth retardation from the physical examination
nine birth weight-gestational age groups before the and confirmed by the weight/length ratio was
first feeding at 3 to 6 hours after birth. The highest demonstrated in infants who became hypogly-
incidence of hypoglycemia, 67% (serum glucose cemic.
level <30 mg/100 ml), occurred in the preterm An added stress in the form of birth hypoxia was
SGA group. It was 25% in the term SCA infants present in the majority of the infants who became
and 18% in post-term SGA babies. Full term ap- hypoglycemic. The combination of reduced energy
propriately grown infants were noted to have a reserves in newborn infants with intra-uterine
10% incidence, and the preterm AGA group had growth retardation, plus the increased utilization of
a general shift toward lower prefeeding glucose carbohydrates during birth hypoxia, resulted in a
levels. Infants of diabetic mothers were generally high incidence of neonatal hypoglycemia in the
large for gestational age and delivered before term; first few hours after birth. Pediatrics, 47:831, 1971,
hence, there was a 38% incidence of hypoglycemia HYPOGLYCEMIA, NEWBORN INFANT, INTRA-UTERINE
in the preterm LCA group. When a serum glucose GROWTH RETARDATION, HYPOXIA, BIRTH, CESTA-

level of’( 20 nig/100 ml was used to define hypo- TIONAL AGE.

T HE relationship between symptomatic with asymptomatic hypoglycemia has not

hypoglycemia in the newborn infant been defined. There may be a relationship
and later central nervous system (CNS) between the duration of asymptomatic hy-
damage has been reported by many au- poglycemia and the onset of symptoms.8
thors.’ A high neonatal mortality, as well There are some neurologically impaired
as later morbidity, occurs in the group of children in the few studies that have been
infants who develop hypoglycemia. A vari- reported.2-
ety of congenital defects, congenital infec- The incidence of hypoglycemia in high-
tions, and perinatal difficulties may be pres- risk or general newborn nurseries is difficult
ent in these infants. to evaluate because of the different criteria
There is some debate over whether the used to define hypoglycemia and because of
CNS abnormality is primary and precedes the dissimilar populations in the various
the hypoglycemia6 or whether the hypogly- nurseries reporting. In general, the inci-
cemia is the cause of CNS damage. Both of dence figures vary from 1 to 5% Pildes,
these views may be valid; there is little ar- et al., who defined hypoglycemia as glu-
gument about the poor outcome of infants cose levels of <20 mg/ 100 ml, gave a 5.7%
who have primary CNS disease. Data are incidence in a special-care nursery. Yet,
now being accumulated which show the de- when less stringent criteria were used, i.e.,
structive effects on the brain of persistent <30 mg/ 100 ml, the incidence was doubled
low blood sugar per se.7 and a few asymptomatic infants were de-
On the other hand, the risk associated tected. Even so, 8 of 12 infants with glucose

(Received August 14; revision accepted for publication December 11, 1970.)
Supported in part by grants-in-aid from NIH #HD 373 and #HD 781 and from Maternal and Child
Health (HEW) through the State of Colorado Department of Public Health in cooperation with the Uni-
versity of Colorado Medical Center.
ADDRESS: (L.0.L.) Box 2776,4200 East Ninth Avenue, Denver, Colorado 80220.

PEDIATRICS, Vol. 47, No. 5, May 1971

831

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832 NEONATAL HYPOGLYCEMIA

GMS
4500

7%
4% (1/14)
(2/48)

3500
38%
(6/16) 10%
(2/40)
(12/126)

2500

25% 18%
(2/Il)
(9/60 (I 1/44)

500
90%

67%
(10/15)
0%

26 30 34 38 42 46
WEEK OF GESTATION

FIG. 1. Incidence of hypoglycemia in newborn infants, classified by birth

weight and gestational age. Glucose levels <30 mg/100 ml prior to first
feeding.

levels between 20 and 30 mg/ 100 ml devel- finding was offset by the early recognition
oped symptoms which could be attributed of hypoglycemia which, in some infants,
to hypoglycemia. persisted and neurological symptoms devel-
A higher incidence of hypoglycemia oc- oped.
curs in infants with intra-uterine growth re- The present study was undertaken to ob-
tardation (IUGR) 11,12 Neligan,13 who tain data on the incidence of hypoglycemia
compared prefeeding glucose levels in in the newborn by birth weight and gesta-
small for gestational age (SGA) versus nor- tional age in a general obstetric service,
mally grown infants, found that 12 of 33 with the aim of providing a more selective
SGA infants had glucose levels below 20 mg method for identifying infants at greatest
/100 ml. risk.
A recent studv,1 using the regular dcx-
trostix methods of measuring whole blood CLINICAL MATERIAL
glucose, revealed data on a total nursery Only infants born at the University of
population tested twice in the first 8 hours Colorado Medical Center were included in
after birth; 213 of 2,000 newborn infants re- the study. The population is composed pri-
quired special care for a variety of perinatal marily of medically indigent patients, but
disturbances. Of the remaining 1,787 appar- there are a small number of private pa-
ently healthy infants, 8.7% had low dcx- tients. It is a referral center for the Rocky
trostix readings (<40 mg/ 100 ml). False Mountain Region so that the obstetric ser-
positive results were encountered but this vice contains a higher than average percent

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 ARTICLES 833

of complicated obstetric cases. The inci- (3% of the births at the University of Colo-
cence of low-birth-weight infants is approx- rado Medical Center), the selection as de-
imately 13%. The management of the ob- scribed above was deemed to be represen-
stetric patient was individualized. Adminis- tative.
tration of fluids and/or glucose intrave- Data were collected over a 2-year period,
nously was not routine. May 1967 May
to 1969. The infants were
A random sample of the nursery popula- examined by one of the investigators, usu-
tion was obtained in the following way. All ally within an hour after birth. A clinical es-
infants who were born during the working timate of gestational age was made, based
hours of the investigators and laboratory on physical characteristics and neurologic
technician were included in the study. In- signs.1#{176}This estimate was compared with
fants were classified by birth weight and the calculated gestational age. If the moth-
gestational age into nine categories.15 On CIS last normal menstrual period was not
any given day, the infants who fell into any known or was uncertain, the infant was not
of the eight groups other than the term ap- included in the study. Also, if the clinical
propriate for gestational age (AGA) group estimate of gestational age did not agree
were studied. If there were no births in the within 2 weeks of the calculated gestational
other eight categories, one or two term age, the infant was not included in the
AGA infants were studied. Since births oc- study. The initial examination included a
cur randomly throughout the 24 hours, with clinical impression of the state of nutrition.
the exception of elective cesarean sections The weight/length ratio17 was used as con-

WEEK OF GESTATION
FIG. 2. Incidence of hypoglycemia in newborn infants, classified by birth
weight and gestational age. Glucose levels <20 mg/100 ml prior to first
feeding.

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834 NEONATAL HYPOGLYCEMIA

firmatory evidence for under- or overnutri- was inserted in one end. This process loos-
lion. ened the clot sufficiently to allow easy sepa-
Information concerning the pregnancy, ration of cells and serum. After centrifuga-
delivery, and neonatal course was tran- tion, the serum was collected directly into
scribed from the medical record to data 50:k pipettes from the cut ends of the capil-
cards, as were the birth weight, length, lary tubes. Glucose was determined by the
head circumference, and weight/length ra- glucose oxidase method as described by
ho. O’Brien, et al.18

METHOD RESULTS
Blood samples were collected from the A group of 374 infants was studied. The
infants at birth (umbilical cord blood), mean cord blood glucose levels in the nine
from a heel stick before the first feeding at birth weight-gestational age categories
approximately 3 to 6 hours after birth and ranged from 75 to 90 mg/100 ml. Fasting
again after a 3 to 4 hour fast on the third or levels at 3 days of age were all above 50 mg
fourth day after birth. Additional samples / 100 ml except for cases which are dis-
were obtained on infants whose serum glu- cussed below.
cose levels were low. The incidence of low fasting glucose
Umbilical cord blood samples were col- levels prior to the first feeding in the nine
lected in plain glass test tubes, allowed to groups can be seen in Figures 1 and 2.
clot, promptly centrifuged, and the serum When a serum glucose level of < 30 mg/
separated from the cells. Postnatal blood 100 ml was used to define hypoglycemia,
samples were obtained from heel sticks in the incidence was
nine birth high in all
plain capillary tubes (0.1 ml capacity). The weight-gestational age categories ( Fig. 1).
blood was allowed to clot and sealing clay The highest incidence of hypoglycemia
occurred in the SGA groups (P < .001).
Preterm SGA infants had the highest mci-
TABLE I dence of 67%, which even with small num-
I N(’IDENCE OF IIYI’OGLYCEMIA (<30 MG/100 ML) IN A bers was significantly higher than that
I. NUR4ERY SERVI(E EXTRA ‘OLATEL) found in the term SGA’s and preterm AGA’s
FROM TUE OBSERVED INCIDENCE
(P = <.001). This group included the
sickest babies and the ones who were
Na iiber
‘Vu inber treated most vigorously. Some of the in-
()bxerred Expected
( /(L5SlfiC.atlOfl . .1(11,1 ?$X1OH. fants demonstrated signs of hypoglycemia
Ineulence Incidence
i,z 1 year
in 1 year within 1 to 2 hours after birth, 11 of 15 re-
quired intravenous therapy either for hypo-
Preterin SGA 10/15 15 10 glycemia, respiratory distress, or hydra-
‘leriti SGA 11/44 80 20
tion.
Post-term s(;A /11 4
Of the term SGA infants, 25% had levels
Preterin A( A 9/60 i30 34 of <30 mg/100 ml. This was significantly
‘lerti, AGA 93i 88 higher than the incidence of 10% found in
Post-term A(;A 179 9
the term AGA infants (P = .004). The in-
cidence of 38% in the preterm large for
Preterm LGA 33 13
‘I’erm IA ,A 99 4 gestational age (LGA) group was higher
Post-term IA;. 1/14 than the percent in preterm AGA or term
LGA (P = .033 and P = <.001 respective-
1,(;17 184
ly) and reflected the obstetric practice of

Expected incidence 11.4%.

preterm delivery of diabetic mothers and
* SGA = Small for gestational age. AGA =AI)I)ropri- the occurrence of hypoglycemia in their
ate for gestational age. LGA = Large for gestational age. offspring.

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 ARTICLES 835

n n n
Pr LGA n’ 6 F LGA fl :48 Po LGA : 14

5 ‘5 ‘5

0 0 I0

5 S 5

- HI_
20 40 60 8o 00 20 mq% 20 40 60 80 100 20 mg% 20 40 60 80 100 20 rng%

n
n.60 n:126 PoAGA n:40
IS

I0

20 40 60 80 00 I20-mg%

n n

Pr SGA ‘5 Po SGA n:II

I0 IC

.ii
20 40
p -
60 80 00 20 mg%
._ iL
mq% 20 40 60 80 00 20 mq%

GLUCOSE
FIG. 3. A normal distribution of glucose levels can be seen in full term AGA, post-term AGA and full
term LGA data. There is a general shift toward lower levels in the preterm AGA group and a bimodal
distribution in the term SGA group. Pr = Preterm. F = Term. Po = Post-term.

Infants who had prefeeding glucose These data were examined in another
levels of < 20 mg/ 100 ml were also ex- way in order to see the distribution of glu-
amined (Fig. 2). With this level, the inci- cose levels in each of the nine groups ( Fig.
dence of hypoglycemia was remarkably re- 3) . A normal distribution of glucose levels
duced in all birth weight-gestational age is apparent in tile term AGA and post-term
categories except the SGA groups (Fig. 2). AGA groups. The peak incidence in these
The incidence fell only from 2% to 21% groups was 50 to 60 mg/ 100 ml, with equal
in the term SGA group and remained the numbers occurring on either side of the me-
highest in tile preterm SGA group (40%). dian. The preterm AGA group showed a
(SGA versus AGA, P = <.001.) general shift toward lower glucose levels;
The incidence as given in the nine birth the mean glucose level was 48 mg/ 100 ml
weight-gestational age groups can be ex- compared to 54 mg/ 100 ml in the term
trapolated by using the numbers of annual AGA group (P = <.05). There were too
admissions to each group to determine the few cases in the preterm and post-term
incidence of hypoglycemia for the total LGA and SGA groups to describe accurate
nursery population (Table I). The number trends. However, there was an apparent bi-
of infants admitted to the general nursery modal distribution in the term SGA group
service who would be expected to have and a shift of the mean glucose level to 44
blood glucose levels of <30 mg/100 ml mg/100 ml, also a signfficant deviation
during the first 3 to 6 hours after birth, was from the mean glucose level found in term
calculated to be 184 out of 1,617 total AGA infants (P = <.05). The finding of a
births, or 11%. bimodal curve in the term SGA group

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836 NEONATAL HYPOGLYCEMIA

suggests that there are two distinct popula- who had prefeeding glucose levels of < 50
tions. In searching for the differences be- mg/100 ml. Both of these were SGA infants
tween the infants who became hypogly- with severe hpoglcemia, i.e., both had
cemic and those who did not, two clinical initial prefeeding glucose levels of < 5 mg/
conditions were evaluated, i.e., the degree 100 ml.
of undernutrition at birth and the presence
of birth complications. DISCUSSION
A low weight/length ratio was used as The fetus receives its supply of nutrients
an index of undernutrition since it describes from maternal sources during gestation and
the weight of the infant in relation to his builds up stores of glycogen and fat late in
length. If the baby is heavy for his length, pregnancy which will tide him over the pe-
he will have a high weight/length ratio as nod from birth until he can establish ade-
seen in infants of diabetic mothers. Con- quate oral nutrition. An important source of
versely, if the or wasted,
baby the
is thin glucose during the immediate postnatal pe-
weight/length ratio will be low. All of the nod is liver glycogen. If in utero anoxia or
term SCA infants studied had a low weight birth asphyxia occurs, this source of carbo-
/length ratio, i.e., a figure which was below hydrate can be partially depleted.19 If, in ad-
the 25th percentile on the Colorado stan- dition, the stores are inadequate, as occurs
dard. in the preterm and undernourished term in-
When the nutritional state of the term fant, then glucose levels would be expected
AGA infants who became hypoglycemic to fall as soon as the available energy
was evaluated, it was found that one of sources have been mobilized. Serum glu-
these infants was a well nourished infant of cose samples then, taken before the first
a diabetic mother ( 1DM ) The
. others, al- feeding, would reflect to some extent the
though appropriate in weight for gesta- state of intra-uterine nutrition and carbohy-
tional age, demonstrated varying degrees of drate reserves.
undernutrition on physical examination In this nursery, the first oral feeding is
which was confirmed by a low weight/ given whenever the vital signs are stable
length ratio. and the infant exhibits hunger; hence,
A history of perinatal stress was found in many fasting samples were, of necessity,
the majority of infants who developed hy- taken by 3 hours of age. The incidence of
poglycemia. Except for the 1DM, 10 of the hypoglycemia may have been higher if the
remaining 11 had complications during la- feeding routine included a mandatory fast-
bor and delivery, resulting in fetal distress, ing period.
low Apgar scores, or required resuscitation. Most investigators are in agreement that
The other
one had a weight/length ratio the mechanisms responsible for hypoglyce-
on the 10th percentile. The two infants with mia in the 1DM are vastly different from
the lowest Apgar scores had glucose levels those in the SGA infant; the one due to hy-
of < 20 mg/lOO ml. perinsulinemia and the other due to inade-
Similarly, a review of the perinatal quate gluconeogenesis rather than a func-
courses of the term SGA infants revealed tion of insulin. The well nourished 1DM
that 9 of 11 hypoglycemic newborn infants can call on his adequate glycogen stores to
had unequivocal evidence of fetal distress elevate his blood glucose. On the other
and varying degrees of neonatal asphyxia. hand, the SGA infant with his small carbo-
In the remaining 33 normoglycemic term hydrate and fat reserves is unable to main-
SGA infants, there were only three with tain an adequate glucose level even when
some evidence of fetal distress (P = his glucose homeostatic mechanisms are in-
<0.005). At 5 minutes of age, these three tact. The period of hypoglycemia in the
had Apgar scores of S or more. 1DM is brief, whereas the state of hypogly-
When the infants were studied at 3 to 4 cemia in the SGA infant will persist and
days of age, there were only two infants worsen unless treated.

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 ARTICLES 837

If the SGA infant can be likened to per- CONCLUSIONS

sons during periods of starvation, one The incidence of hypoglycemia was de-
would anticipate suppression of insulin pro-
termined in newborn infants in a general
duction and, in turn, see a hyperglycemic obstetric service.
response to postnatal feeding. Neonatal hy-
A random sample of patients was studied
perglycemia has been reported in the litera- from nine birth weight-gestational age
ture as occurring mainly in SGA and post- groups and the data are given for each
term infants.b022 In the course of this study, group. SGA infants gave the highest mci-
a high, fasting glucose level at 3 days of age dence of hypoglycemia, with preterm AGA
was discovered in four infants (> 115 mg/ infants being next. IDM’s were predomi-
100 ml) . They were either post-term or nately in the preterm LGA group.
SGA infants and all showed evidence of Evidence of IUGR from the physical ex-
IUGR. All had weight/length ratios below amination and confirmed by the weight/
the 15th percentile. Further information is length ratio was demonstrated in infants
needed on such undernourished newborn who became hypoglycemic.
infants to document the role of insulin in An added stress in the form of birth hy-
hyperglycemia. poxia was present in the majority of the in-
The definition of hypoglycemia in the fants who became hypoglycemic. The corn-
newborn based on the serum glucose level bination of reduced energy reserves in new-
is arbitrary. Significant disease has been born infants with IUGR, plus the increased
recognized in infants where glucose levels utilization of carbohydrates during birth
are below 20 mg/100 ml and there are hypoxia, resulted in a high incidence of
some infants with glucose levels of 20 to 30 neonatal hypoglycemia in the first few
mg/100 ml who develop symptoms similar hours after birth.
to those with glucose levels below 20 nig/
100 ml. Since the trend in newborn care is REFERENCES
toward identifying infants with potential, as 1. Cornblath, M., Odell, C. B., and Levin, E. Y.:
well as obvious problems, the number of in- Symptomatic neonatal hypoglycemia associ-
fants with serum glucose levels below 20 ated with toxemia of pregnancy. J. Pediat.,
mg/100 ml and below 30 mg/ 100 ml is 55:545, 1959.
presented. 2. Haworth, J. C., and McRae, K. N.: The neuro-
logical and developmental effects of neona-
A serum glucose level of <30 mg/ 100 ml tal hypoglycemia. Canad. Med. Ass. J., 92:
served to identify potentially sick infants 861, 1965.
since this level incidentally was associated 3. Chance, G. \V., and Bower, B. D.: Hvpoglyce-
with IUGR and perinatal stress. mia and temporary hyperglycemia in in-
fants of low birth weight for maturity. Arch.
SUMMARY Dis. Child., 41:279, 1966.
4. Brown, R. J. K., and Wallis, P. C.: Hvpoglyce-
The infants who were found to be vulner- mia in the newborn infant. Lancet, 1:1278,
able, other than the 1DM, included all SGA 1963.
newborn infants, those with evidence of 5. Knobloch, H., Sotos, J. F., Sherard, Jr., E. S.,
IUGR, and those requiring resuscitation at Hodson, W. A., and Wehe, R. A.: Prognostic
and etiologic factors in hypoglycemia. J.
delivery. Prefeeding glucose levels gave
Pediat., 70:876, 1967.
valuable information about carbohydrate 6. Ethridge, J. E., Jr.: Hypoglycemia and the
reserves. Some severely malnourished in- central nervous system. Pediat. Clin. N.
fants were found to become hypoglycemic 14:865,
Amer., 1967.
within the first hour after birth. 7. Anderson, J. M., Mimer, R. D. C., and Strich,
S. J.: Effects of neonatal hypoglycemia on
Follow-up studies of infants with neona-
the nervous system: A pathological study. J.
tal hypoglycemia, which take into account
Neurol. Neurosurg. Psychiat., 30:295, 1967.
IUGR and perinatal asphyxia, are needed 8. Raivio, K. 0.: Factors affecting the develop-
to unravel the roles of each in relation to ment of symptoms in neonatal hypoglvce-
later central nervous system damage. mia. Ann. Paediat. Fenn., 14:105, 1969.

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838 NEONATAL HYPOGLYCEMIA

9. Pildes, R., Forkes, A. E., O’Connor, S. M., and 17. Lubchenco, L. 0., Hansman, C., and Boyd, E.:
Cornblath, M.: The incidence of neonatal Intrauterine growth in length and head cir-
hypoglycemia-A completed survey. J. Pe- cumference as estimated from live births at
diat., 70:76, 1967. gestational ages from 24 to 42 weeks. PEDI-
10. Criffiths, A. D.: Association of hypoglycemia ATRICS, 37:403, 1966.
with symptoms in the newborn. Arch. Dis. 18. Ibbott, F., O’Brien, D., and Rodgerson, D. 0.:
Child., 43:688, 1968. Laboratory Manual of Pediatric Microbio-
11. Campbell, M. A., Ferguson, I. C., Ilutchison, chemical Techniques, ed. 4. New York: Har-
J. H., and Kerr, M. M.: Diagnosis and treat- per and Row, p. 308, 1968.
ment of hypoglycemia in the newborn. Arch. 19. Shelley, J. J.: The metabolic response of the

Dis. Child., 42:353, 1967. fetus to hypoxia. J. Obstet. Cvnaec. Brit.

12. Blum, D., Dodion, J., Wilkin, P., and Hubinont, Comm., 76:1, 1969.
P. 0.: Studies on hypoglycemia in small-for- 20. Ceehuysen, J.: Temporary idiopathic iieo-
natal hyperglycemia. PEDIATRIcS, 38:1009,
dates newborns. Arch. Dis. Child., 44:304,
1969.
1966.
21. Lewis, S. R., and Mortimer, P. E.: Idiopathic
13. Neligan, C.: Idiopathic hypoglycemia in the
neonatal hvperglycaemia. Arch. Dis. Child.,
newborn. In Gairdner, D., ed.: Recent Ad-
39:618, 1964.
vances Pediatrics. London: Churchill, p.
22. Ferguson, Q. \V., and Milner, R. D. C.: Tran-
110, 1965.
sient neonatal diabetes mellitus in siblings.
14. Partanen, Y., and Heinonen, K.: Screening for
Arch. Dis. Child., 45:80, 1970.
neonatal hypoglycemia. Lancet, 2:1251,
1969. Acknowledgment
15. Battaglia, F. C., and Lubchenco, L. 0.: A The authors wish to thank Ailene Hofer, re-
practical classification of newborn infants by search technician, for her valuable contribution to
birth weight and gestational age. J. Pediat., this work. Her interest, availability, and gentleness
71:159, 1967. with the infants endeared her to the nursery staff
16. Lubehenco, L. 0.: Small for date infants. Pe- and made acquisition of data a pleasant, as well as
diat. Clin. N. Amer., 17:125, 1970. a meaningful task.

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INCIDENCE OF HYPOGLYCEMIA IN NEWBORN INFANTS CLASSIFIED BY
BIRTH WEIGHT AND GESTATIONAL AGE
Lula O. Lubchenco and Harry Bard
Pediatrics 1971;47;831
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PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly publication, it
has been published continuously since 1948. PEDIATRICS is owned, published, and trademarked by the
American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village, Illinois, 60007.
Copyright © 1971 by the American Academy of Pediatrics. All rights reserved. Print ISSN: 0031-4005.
Online ISSN: 1098-4275.

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 INCIDENCE OF HYPOGLYCEMIA IN NEWBORN INFANTS CLASSIFIED BY
BIRTH WEIGHT AND GESTATIONAL AGE
Lula O. Lubchenco and Harry Bard
Pediatrics 1971;47;831

The online version of this article, along with updated information and services, is located on
the World Wide Web at:
/content/47/5/831

PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly publication,
it has been published continuously since 1948. PEDIATRICS is owned, published, and trademarked
by the American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village,
Illinois, 60007. Copyright © 1971 by the American Academy of Pediatrics. All rights reserved. Print
ISSN: 0031-4005. Online ISSN: 1098-4275.

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