Blood Glucose Monitoring and Treatment in the Newborn and Transition Nurseries
Risk factors for hypoglycemia
No, standard
1. Symptomatic infant*: tremors,
twitching,
newborn
carejitteriness,
Risk factors for Hypoglycemia
See Box
irritability, exaggerated Moro reflex, high pitched cry,
seizures, apnea, hypotonia, poor feeding, respiratory distress,
temperature instability, and/or coma
2. Infant of diabetic mother
3. Infant of gestational diabetic mother
4. Large for gestational age (LGA) infant
5. Small for gestational age (SGA) infant
6. Low birthweight infant (< 2500 grams)
7. Premature infant ≤ 36 6/7 weeks
8. Infant with clinically suspected sepsis
9. Post asphyxiated infant (Apgar < 5 at 5 min)
10. Infant with Rh- incompatible hemolytic
disease
11. Infant with polycythemia
12. Infant with Beckwith-Wiedemann Syndrome
No, standard newborn care
Yes, Glucose Protocol
Initiate feed within 1st hour of life
If symptomatic* check blood glucose immediately if not
check 1st blood glucose within 1st hour of life
Check additional scheduled blood glucoses
at 3, 6, 12, and 24 hr of age.
Glucose
≥ 45 mg/dl
Glucose
25-44 mg/dl
Frequent feedings
Continue scheduled
screening
Able to feed by mouth?
Glucose
< 25 mg/dl
No
0 to 4 hr of age
Yes, breastfeed if hasn't in last hour or feed donor
breastmilk or stock formula (SF), ~15-20 ml
> 4 hr of age
Transfer to Transition
Obtain IV access
D10W bolus 2 ml/kg
Recheck blood
glucose in 30 min
Glucose
≥ 45 mg/dl
Glucose
25-44 mg/dl
Frequent feedings
Continue scheduled
screening
Repeat po
supplementation of donor
breastmilk or SF
Transfer to NICU†
Obtain IV access
D10W bolus 2 ml/kg
Recheck blood
glucose in 30 min
Recheck blood
glucose in 30 min
Glucose
≥ 45 mg/dl
Glucose
25-44 mg/dl
Frequent feedings
Continue scheduled
screening
Transfer to NICU†
Obtain IV access
D10W bolus 2 ml/kg
Glucose
≥ 45 mg/dl
Glucose
< 45 mg/dl
Frequent feedings
Continue scheduled
screening
Transfer to NICU†
Repeat D10W bolus
2 ml/kg
†In NICU: Start D10W-1/4NS continuous
infusion at GIR≥5 mg/kg/min. Recheck glucose
in 30 min. Target NICU glucose > 50 mg/dl.
Adamkin DH, Committee on Fetus and Newborn. Postnatal Glucose Homeostasis in Late-Preterm and Term Infants. Pediatrics, 2011; 127(3):575-579.
Written: 03/05/2013 Kelly Wood, MD Reviewed: 04/02/2013 Jonathan Klein, MD; Shani Cunningham, DO Revised: 01/30/2014 K Wood, J Klein