Routine newborn blood glucose testing?

Specialties Ob/Gyn

Published

Our nursery has been routinely performing a blood glucose test upon admission and in 2 hours. The majority of peds and GPs agree that this will diagnose and prompt intervention for the asymptomatic infants and prevent brain damage by quick treatment. One physician insists that only LGA, SGA and infants of gestational diabetic mothers are to be tested. Our standards and orders suggest routine screening at birth and in two hours whether at risk or not as well as PRN.

WHAT does everyone else do? Is there a national SOC ? Where would we find literature to support one or the other of these practices?

We are all very stressed when we forget and test his babies. And we need some data to support or delete our current practice. It would obviously cost less to only test those at risk babies as listed.

What do you think? Any help would be great!!!!

Thanks

Specializes in OB.
We don't do routine testing, either. LGA, SGA, IDM babies, stressful deliveries, symptomatic babies. After transition, we'll check a baby who isn't nursing well, to see if it's something to worry about.

We are happy if it's over 45mg/dl, otherwise we draw a stat blood glucose for correlation. We notify the doc when we get that result back.

We won't draw a stat blood glucose unless it's under 40mg/dl X 2. After the first time that it is under 40, we'll have mom breastfeed if she is opposed to any formula being given or give formula if mom states she will not be breastfeeding, and recheck after 30 minutes. If it has not gone up, then we'll draw a stat blood glucose and call the doc with results.

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We do blood sugars on LGA, SGA,

Ditto!

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We don't do routinely do BS either. Only for babies at risk.

We did do them routinely but stopped a few years ago.

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We do the same thing... SGA, LGA, diabetic mother, preterm or posttermers...or those who are symptomatic. We used to do all babies but recently changed the policy.

QUOTE=imenid37]I don't know what or if AAP has guidelines for neonatal glucose screenings. We only do high risk babies or those who exhibit sx's of hypoglycemia. LGA,SGA, less than 37 wk. or more than 42 weeks, infant of DM mom per routine orders. We also (usually) screen those w/ low apgars, tachypnea, tachycardia, jittering, lethargy, or low temp's,babies who are/will be NPO, etc.

Honestly, I don't think we miss much and I really don't see the need for all babies to get a glucose. It may just be how I am used to doing things because I know a lot of places do glucoses on ALL babies. There is also some debate on treating asymptomatic glucoses in term newborns which are in the 35+ range. This has been going on for at least 10 years. (sorry for any other bad spelling/poor typing today)

I can't find anything from AAP. It looks like they might be coming out w/ a new position statement.An AAFP article does state that routine glucose screening in the healthy, term neonate is not indicated. http://www.aafp.org/afp/20001115/tips/14.html

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Specializes in NICU, Infection Control.

Same here--no routine testing.

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Our nursery has been routinely performing a blood glucose test upon admission and in 2 hours. The majority of peds and GPs agree that this will diagnose and prompt intervention for the asymptomatic infants and prevent brain damage by quick treatment. One physician insists that only LGA, SGA and infants of gestational diabetic mothers are to be tested. Our standards and orders suggest routine screening at birth and in two hours whether at risk or not as well as PRN.

WHAT does everyone else do? Is there a national SOC ? Where would we find literature to support one or the other of these practices?

We are all very stressed when we forget and test his babies. And we need some data to support or delete our current practice. It would obviously cost less to only test those at risk babies as listed.

What do you think? Any help would be great!!!!

Thanks

Routinely testing all newborns is NOT standard of care. It is overkill. Read the AAP Guidelines.

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We never do "routine" anything. If the baby is healthy and has breastfed and has some fat stores and isn't showing any symptoms and doesn't have any risk factors, our docs would not be pleased that we poked them for a blood sugar. It isn't indicated.

Deb already thanked you but I have to add mine.

Our babies room in with moms; we don't have a staffed nursery. Symptomatic babies or babes over 9 pounds is about it.

steph

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We get a glucose on all of our babies in the nursery when they first come in. Our pediatricians all have different blood sugar orders for LGA, SGA, diabetic moms...

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Specializes in NICU.
Our nursery has been routinely performing a blood glucose test upon admission and in 2 hours. The majority of peds and GPs agree that this will diagnose and prompt intervention for the asymptomatic infants and prevent brain damage by quick treatment. One physician insists that only LGA, SGA and infants of gestational diabetic mothers are to be tested. Our standards and orders suggest routine screening at birth and in two hours whether at risk or not as well as PRN.

WHAT does everyone else do? Is there a national SOC ? Where would we find literature to support one or the other of these practices?

We are all very stressed when we forget and test his babies. And we need some data to support or delete our current practice. It would obviously cost less to only test those at risk babies as listed.

What do you think? Any help would be great!!!!

Thanks

Our unit "used to" routinely check glucosticks after birth but now we don't. We are very diligent (at least try to be) about the pain inflicted upon the newborns in that "golden hour" after birth. Babies that have been "on the admit table" having lines inserted etc. for more than an hour will have a glucostick done, I.D.D.M's will as well. Furthermore, we would check S.G.A's and L.G.A's in the first hour but anything "regular" gets done at the bedside in or around 2 hours of age. We are into giving sucrose....anyone else do that?

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We get a glucose on all of our babies in the nursery when they first come in. Our pediatricians all have different blood sugar orders for LGA, SGA, diabetic moms...

Maybe your manager could get that changed. If these peds are all giving you different standards, then they are NOT (ANY of them) following their own academy's guidelines. If you check the AAP's polict statement, you will see that routine glucose testing is no longer suggested. It results in so many totally unnecessary heelsticks and can really screw up the breastfeeding as well.

My guess is (no offenswe here) that if you are routinely doing glucose checks, then you are probably doing other procedures that are outmoded and that interfere with babies and mothers being together (like baths away from the bedside and babies in holding nurseries.

You might like it if your manager got some of your unnecessary protocols changed.

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Maybe your manager could get that changed. If these peds are all giving you different standards, then they are NOT (ANY of them) following their own academy's guidelines. If you check the AAP's polict statement, you will see that routine glucose testing is no longer suggested. It results in so many totally unnecessary heelsticks and can really screw up the breastfeeding as well.

My guess is (no offenswe here) that if you are routinely doing glucose checks, then you are probably doing other procedures that are outmoded and that interfere with babies and mothers being together (like baths away from the bedside and babies in holding nurseries.

You might like it if your manager got some of your unnecessary protocols changed.

You are correct. We do have a nursery and we do the baths in that nursery. I do not agree fully with this but that is how they do it at this facility. We have seperate L&D and PP units. When more comes over to PP the baby goes to the nursery of about 1 1/2 hours to 2 hours sometimes more depending on their temps. And mom gets to sit in her room and wait for her new baby. I really can't get over how many mother's actually want their infant to be taken to the nursery. I work night shift and some night the nursery is just bursting at the seams. :crying2:

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You are correct. We do have a nursery and we do the baths in that nursery. I do not agree fully with this but that is how they do it at this facility. We have seperate L&D and PP units. When more comes over to PP the baby goes to the nursery of about 1 1/2 hours to 2 hours sometimes more depending on their temps. And mom gets to sit in her room and wait for her new baby. I really can't get over how many mother's actually want their infant to be taken to the nursery. I work night shift and some night the nursery is just bursting at the seams. :crying2:

Keeping babies with mom and out of the nursery is often in how you approach the subject. Research indicates moms actually rest better with baby in the room with them.

As for glucose checks: follow the pernatal guidelines published in the 5th edition by the AAP/ACOG, guidelines for perinatal care

Change is hard for many nurses and MD's. The bennefits to the families we care for are worth the extra effort to promote the change.

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