Neonatal Hypoglycemia: A Systematic Review of International and Local Clinical Guidelines with Clinical Implications

Background/Objectives: Neonatal hypoglycemia is one of the most common metabolic disturbances in the first 24–72 h of life. Despite its frequency, international and local guidelines differ regarding screening strategies, operational thresholds, and escalation pathways. This study is a systematic comparative review of international and local clinical guidelines regarding neonatal hypoglycemia management. Methods: We performed a systematic review of major guideline frameworks (AAP, BAPM, PES, CPS, Te Tohu Waihonga New Zealand, and Australian state-based guidance) and compared recommendations for risk factors, screening, treatment thresholds, and NICU admission. Results: All guidelines recommended targeted screening of at-risk neonates and immediate treatment of symptomatic hypoglycemia. However, there was no universal agreement on timing of the first blood glucose (BG) measurement, screening frequency, or minimum blood glucose threshold for initiating therapy during the transitional period. Contemporary guidelines endorse 40% oral dextrose gel as first-line therapy in selected cases. Conclusions: Despite numerical differences, guidelines converge on core management principles. Further comparative studies are required to define standardized intervention thresholds and optimal measurement strategies.