# Neonatal Hypoglycaemia Management Guideline appraisal using the AGREE II instrument and report of variations in unit guidelines in Australia and New Zealand

## TL;DR

This study evaluates neonatal hypoglycaemia management guidelines in Australia and New Zealand, finding significant inconsistencies and low quality in many guidelines.

## Contribution

The study is the first to systematically appraise neonatal hypoglycaemia guidelines using AGREE II and report on variations in management practices.

## Key findings

- Only 17 out of 29 hospitals provided guidelines, and none scored above 50% in all AGREE II domains.
- Glycaemic thresholds for hypoglycaemia varied between 2.0 and 2.6 mmol/L across guidelines.
- Most guidelines recommended buccal gel as first-line treatment despite limited evidence.

## Abstract

To assess the quality and rigour of Neonatal Hypoglycaemia guidelines used in the major Australian and New Zealand neonatal care centres. To compare and highlight any major differences in management guidelines between centres.

All level III NICUs in Australia and New Zealand were invited to participate. The AGREE II (Appraisal of Guidelines, Research & Evaluation) was used to critically appraise the guideline for the management of neonatal hypoglycaemia. Recommendations regarding definition, treatment, method of testing and admission criteria were compared from the guidelines provided.

Neonatal Hypoglycaemia guidelines were received from 19 of the 29 invited hospitals; two guidelines were excluded as the hospitals providing these guidelines did not provide care for inborn neonates. None of the 17 guidelines received a standardised score of 50% or higher on all six domains of the AGREE II tool. The mean scores of each of the AGREE II domains were as follows: Scope and Purpose 76%; Stakeholder Involvement 41%; Rigour of Development 20%; Clarity of Presentation 66%; Applicability 30% and Editorial Independence 0.1%. The glycaemic threshold defining hypoglycaemia varied between 2.0 and 2.6 mmol/L in the guidelines. True blood glucose using either a glucose oxidase method or blood gas analyser was recommended as the first line test in 35% of the guidelines. Fifteen of the 17 guidelines recommended buccal gel as first‐line treatment of hypoglycaemia.

Neonatal Hypoglycaemia guidelines are of varying methodological quality. There are inconsistences in the management of hypoglycaemia across neonatal units in Australia and New Zealand.