New study identifies affordable, accurate tools to detect low blood sugar in newborns globally

Every year, millions of newborns — especially those born premature, underweight or sick — are at risk of neonatal hypoglycemia, a dangerous drop in blood sugar that can lead to seizures, brain injury and lifelong developmental challenges if not detected quickly. Early testing and treatment are essential, but many hospitals around the world lack access to reliable devices designed specifically for newborns.

A new study led by researchers at Rice360 Institute for Global Health Technologies, in collaboration with global clinical partners, offers a promising path forward. Published in BMC Pediatrics, the research systematically evaluated the accuracy and reliability of 11 commonly available point-of-care glucometers — small handheld devices widely used at home to monitor diabetes in adults — to determine which could safely be adapted for neonatal care in resource-constrained settings.

“We know that hypoglycemia can be life-threatening for newborns, and timely glucose monitoring saves lives,” said Meaghan Bond, lead author and Rice University lecturer and research scientist. “In many hospitals where neonatal mortality is highest, specialized neonatal glucometers are simply too expensive or unavailable. However, we know there are many low-cost glucometers, such as those you might find at CVS or Walgreens, that are designed for adults to manage their diabetes at home. We wanted to know if any of these affordable, widely available devices could be used safely for newborns instead, and if so, which ones.”

To answer that question, the researchers recreated neonatal blood conditions by modifying adult samples to match newborn glucose concentrations and hematocrit ranges, which are different in newborns and adults and could affect glucometer performance. They then compared each device’s results to readings from a clinical laboratory analyzer considered the gold standard.

“This approach allowed us to rigorously and repeatedly test performance at glucose levels that matter most for babies without needing large volumes of clinical samples from fragile newborns,” Bond said.

The results showed several low-cost glucometers produced reliable readings even at hematocrit and glucose ranges relevant for newborns, while others did not perform accurately enough at these ranges to be safe for neonatal use. Devices were evaluated based on accuracy and precision at neonatal ranges and consumable cost, all critical considerations for hospitals with limited resources.

Top performing low-cost devices include the Accu-Chek Guide, GuideMe, Instant and Performa.

“These findings are exciting because they offer clinicians real, evidence-based choices,” said Rebecca Richards-Kortum, the Malcolm Gillis University Professor at Rice, co-author and co-director of Rice360. “In places where specialized devices are financially out of reach, these results can directly inform purchasing decisions and clinical protocols. Additionally, these testing methods can guide other researchers interested in performing quick laboratory evaluations of new devices that come to market instead of requiring clinical samples from newborns.”

The work supports the mission of NEST360, an international alliance dedicated to improving survival for small and sick newborns in Africa. As a part of the alliance, Rice researchers worked closely with pediatrician co-authors in Nigeria and Malawi to test glucometers at glucose and hematocrit levels relevant for newborns in these settings.

“As hospitals build strong neonatal care systems, diagnostics like these are foundational,” said Maria Oden, teaching professor of bioengineering, co-author and co-director of Rice360. “These findings enable both clinicians and policymakers to make smarter investments that directly improve survival and long-term outcomes.”

This research was supported through NEST360 with thanks to the Gates Foundation, ELMA Philanthropies, the Children’s Investment Fund Foundation, The Lemelson Foundation, Sall Family Foundation and the Ting Tsung and Wei Fong Chao Foundation.