IN A TERM, GROWTH-RETARDED 10-HOUR-OLD NEONATE WITH SOME HYPOTONIA, JITTERINESS, MODERATE TACHYPNEA, AND A BLOOD GLUCOSE OF 10 MG/DL ASSESSED BY A RAPID REAGENT TEST, THE FOLLOWING IS THE MOST APPROPRIATE IMMEDIATE COURSE OF ACTION

• A. Send a confirmatory blood glucose sample and start enteral feedings
• B. Start enteral feedings and send a blood sample for insulin determination
• C. Send a confirmatory blood glucose sample and start an intravenous glucose infusion ✓
• D. Give a dose of epinephrine and start enteral feeds
• E. Repeat the rapid reagent test in 30 min and begin enteral feeds

In this scenario, the critical low blood glucose level (hypoglycemia) in the neonate requires prompt intervention to prevent potential neurological damage or even death. Confirming the blood glucose level through a laboratory test is essential to ensure accuracy before initiating treatment. Starting an intravenous glucose infusion will rapidly raise the blood sugar levels and provide the necessary energy source for the newborn’s brain and other vital organs.

In other words, the most appropriate immediate course of action for a growth-retarded 10-hour-old neonate with hypotonia, jitteriness, moderate tachypnea, and a blood glucose of 10 mg/dL assessed by a rapid reagent test would be C. Send a confirmatory blood glucose sample and start an intravenous glucose infusion.

• Confirmatory Blood Glucose Sample: It is crucial to confirm the low blood glucose level with a more accurate laboratory test before initiating any treatment. Rapid reagent tests can sometimes yield false results, so confirming the blood glucose level is essential to avoid unnecessary interventions.
• Start an Intravenous Glucose Infusion: Given the critical nature of hypoglycemia in neonates, especially in symptomatic cases like this one, prompt correction of low blood glucose levels is necessary to prevent potential neurological damage or seizures. Intravenous glucose infusion is the fastest way to raise blood sugar levels in such cases.
• Enteral Feedings: While enteral feedings are important for long-term management of neonatal hypoglycemia, they are not the immediate priority in this scenario. Intravenous glucose should be administered first to rapidly correct the low blood sugar levels.
• Epinephrine: Epinephrine is not indicated in this case as the primary issue is hypoglycemia rather than a condition requiring epinephrine administration.
• Repeat Rapid Reagent Test: Waiting for 30 minutes to repeat the rapid reagent test could delay necessary treatment for the neonate’s hypoglycemia. Immediate intervention with intravenous glucose is crucial in such cases.