Blood glucose monitoring and treatment in the Newborn Nursery
Risk factors for hypoglycemia
1. Symptomatic infant:
Initiate feed within 1st hour of life if able to
feed by mouth
tremors, twitching, jitteriness, irritability, exaggerated Moro
reflex, high pitched cry, seizures, apnea, hypotonia, poor
feeding, cyanosis, temperature instability, and/or coma
Risk factors for Hypoglycemia
See Box
2. Infant of diabetic mother
3. Infant of gestational diabetic mother
4. LGA infant
5. SGA infant
6. Low birthweight infant (< 2500 grams)
7. Premature infant ≤ 36 6/7 weeks
8. Post asphyxiated infant (Apgar < 5 at 5 min)
9. Infant with Rh- incompatible hemolytic disease
10. Infant with clinically suspected sepsis
11. Infant with polycythemia
12. Infant with Beckwith-Wiedemann Syndrome
No, standard newborn
care
Yes, Glucose Protocol
Check 1st blood glucose 30 min after first
feed or if unable to eat at 1 hr of age.
Check additional scheduled blood glucoses
at 3, 6, 12, and 24 hr of age.
.
Glucose
25-44 mg/dl
Glucose
≥ 45 mg/dl
Frequent feedings
Continue scheduled
screening
Able to feed by mouth?
Glucose
< 25 mg/dl
No
Obtain IV access
D10W bolus 2 ml/kg
Yes, breastfeed if hasn't in last hour or feed
donor breastmilk or stock formula (SF)
~15-20 ml
Recheck blood
glucose in 30 min
Recheck blood
glucose in 30 min
Glucose
25-44 mg/dl
Glucose
≥ 45 mg/dl
Repeat po
supplementation of
donor breastmilk or SF
Frequent feedings
Continue scheduled
screening
Glucose
< 45 mg/dl
Glucose
≥ 45 mg/dl
Repeat D10W bolus
2 ml/kg
Transfer to NICU
Frequent feedings
Continue scheduled
screening
D10W-1/4NS continuous infusion at GIR 5 mg/kg/min
Target NICU glucose > 50 mg/dl
Recheck blood
glucose in 30 min
Glucose
25-44 mg/dl
Glucose
≥ 45 mg/dl
D10W bolus 2 ml/kg
Transfer to NICU
Frequent feedings
Continue scheduled
screening
D10W-1/4NS continuous infusion at GIR 5 mg/kg/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: 03/05/2013 Jonathan Klein, MD; Shani Cunningham, DO