Newborn blood glucose sticks

[queenjean]

I have a question. I would like to hear from other nurses, what you do in your hospital regarding blood glucose testing in newborns.

Here's our basic protocol. Any infant over 3800 grams, any infant over 40 weeks, any infant below 2500 grams, and any infant before 37 weeks has their blood sugar tested per protocol. The protocol is every hour x 3 hours, then every three hours x 24 hours.

This seems a bit over the top for me. 3800 grams is around 8 1/2 pounds! The last place I worked, we did it if they were over 4500 grams, and then only once (unless it was low, they exhibited signs of low sugar, or they weren't nursing well). These poor babes are getting so many sticks, their heels are black and blue. Some docs specifically order it to be dc'd after three normal CBGs--but many don't.

Is this similar to your facility routines? I would like to say something, to push for updating these protocols to a more baby-friendly schedule--but perhaps this is the norm?

What is your blood sugar protocol? Where do your references and standards for your protocols come from?

Thanks in advance,

Jean

[maregram]

Our hospital just recently up'd the anty with the glucose protocol. They say that 'evidence-based practice' says that you need 4 consecutive glucoses >60! Some of our babies are getting sticks for 24hrs or more! Only because if there's a glucose below 60, lets say 58 on any one of them ... then you have to start all over again!!! It's ridiculous. I've asked to see the research on this as I find it hard to believe that the way we are doing it is 'evidence-based'. Any feedback on this would be greatly appreciated.

[queenjean]

Oh my gosh, greater than 60! I'd like to see that evidence as well.

[beckinben, CNM]

Here is one evidence-based protocol.

http://www.bfmed.org/ace-files/protocol/hypoglycemia.pdf

Unfortunately, my facility falls into the "we test everyone" category.

[maregram]

Thanks for the link. It was informative. Just wanted to clarify that our babies are not routinely screened, only those that are symptomatic and fall into a high-rish category. The concern I have with our protocol is the 4 consecutive >60 results. If anyone comes across that evidence I'd really like to see it. It's new for us and I don't see anyone else doing it.

Thanks again for the article!

[danissa, LPN, LVN]

Tonite, I got a 37 weeker, (yep, Diabetic mum, Para 4!!!) Baby weighed 5660 grammes, over 12 lbs 5 oz! Sugars 2.1mmls, rising to 4.8 mmls, after Dex 10% bolus and infusion, but with evident respiratory distress. We check sticks every hour, but things vary with individual babies.

[lmc512]

The first hospital I worked at, the policy was babies >42 wk, 4200 gms, and

Now the hospital I work at now does blood sugars out the WAZOO (spelling?) they do so many sugars i'm not even totally sure what the policy states. i think for diabetics they do ac time 24 hours! then they measure all babies and plot them on this chart to decide if they are lga, sga, aga. for the past 10 years i thought a baby that was 40 weeks and 8-4 is an avergae baby, but oh no, not at this fine institution. we had better check sugars AC, PC, and whenever else until the kid is approximately 5 years old! then they do the sugars on this great machine called an ISTAT that takes about 25 minutes to actually give you a result after giving 12 error readings so that you have to start over. anyways....thats another rant. but i too wish this hospital that is supposed to be one of the best teaching hospitals would jump into 2008 with their policys!