1.
Assess risk factors for hypoglycemia. If present, feed immediately and initiate algorithm below. Monitor preprandial glucose for first 12 hours of life. For SGA and <37 wk infants monitor preprandial glucose for first 24 hours of life. Risk factors include: a.
Maternal Diabetes (Type I or Gestational) b.
Stress c.
Hypothermia d.
<2.5 kg e.
>4 kg f.
<37 wk g.
>41 wk h.
SGA < 10 th percentile (follow glucose for 24 hours) i.
LGA >90 th percentile
Minimize reduction in temperature @ birth by:
1.
Thorough drying of skin and scalp
2.
Use of cap
3.
Placing skin-to-skin with mother
4.
Swaddling with warm blankets
5.
Use of preheated radiant warmer.
2.
Observe for symptoms of hypoglycemia. For any symptomatic infant with glucose <44 after initial feeding, call
primary MD and transfer to SCN for IV dextrose. Symptoms of hypoglycemia include: a.
Lethargy b.
Stupor (e.g. stunned, dazed, dull) c.
Hypotonia d.
Jitteriness
1.
If asymptomatic, but risk factors present, breastfeed 15 min (or bottle)
within 1 hr after birth. Check precision glucose in 30 min.
2a.
Serum or Precision <25
Call primary MD
Transfer to NICU/SCN
For IV dextrose.
2b.
Precision >25 and <44
Breastfeed 15 min, then supplement 5ml/kg of expressed breast milk or 20 kcal formula via gavage, SNS or bottle.
3.
Recheck serum glucose 1 hr after feeding.
2c.
Precision >44
Breastfeed or bottle every
2-3 hr and monitor preprandial precision glucose until 12 hrs of life
(24 h for SGA or <37wk)
If <25 go to box 2a, if >25 and <44 go to box 2b.
4a.
Precision <44
Call primary MD
Transfer to NICU/SCN
For IV dextrose.
3a.
Serum Glucose >25 and <44
Call Primary MD
Breastfeed 15 min then supplement 5 ml/kg with
BM or 24 kcal formula via gavage, SNS or bottle.
4.
Recheck precision glucose 1 hr after feeding.
3b.
Serum Glucose >44
Breastfeed 15 min then supplement 5 ml/kg
BM or 20kcal formula every 2-3 hr and monitor preprandial precision glucose.
If >44 x2 stop supplements and go to box 2c.
If <44 go to box 3a.
4b.
Precision >44
Breastfeed then supplement 5ml/kg 24 kcal formula every 2-3 hr and monitor preprandial precision glucose.
If >44 x2, change to 20 kcal formula and go to box 3b. If <44, go to box 4a.