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Blood sugar guidelines for neonates

Posted

Specializes in Maternity.

What are your guidelines for hypoglycemia in newborns? I am at a new facility and the neonatologist is insisting that after day 2, the blood sugar needs to be between 60 and 70. The policy is above 50 first day of life. In my old facility, the policy was above 40 first day of life and then above 50 after that. This physician says that the current evidence says the blood sugar has to be above 60 and that the Academy of Pediatrics and breastfeeding medicine has it wrong. What is your practice and is there new evidence to support a BS over 60? I'm getting frustrated when trying to support my breastfeeding families.

LibraSunCNM, MSN

Specializes in OB. Has 10 years experience.

Do you routinely check blood sugars on all babies for 2 days? When I worked in mother/baby, only babies of diabetic moms or LGA babies were on a glucose check series, which was at 1, 2, 4, 6, 12, and 24 hours of life. We didn't continue after that and we didn't check blood sugars on the rest of the babies at all, unless they looked jittery. I'm doubtful of this pediatrician's claims, I haven't heard of any recent evidence supporting him/her.

RNIBCLC

Specializes in Maternity.

We do the same for our babies. Newborns born to either GDM or type 2 diabetes and symptomatic newborns. I think he is making it up. Unfortunately, he runs the show and obviously does not trust breastfeeding.

LibraSunCNM, MSN

Specializes in OB. Has 10 years experience.

That's so frustrating, and unfortunately common. The job I had on the mother/baby unit was at a recently-certified Baby Friendly hospital, and the pediatricians were actually some of our biggest roadblocks to getting certified, with very outdated/incorrect knowledge about breastfeeding. Where I work now as a midwife we are "trying" to go BF, and again, peds continues to insist that formula is necessary way more than it is clinically indicated by current evidence. :-(

sadiemae1123

Has 16 years experience.

I'd ask the pediatrician for the research paper he is basing his orders on.

I'd also make sure that there was a hospital policy in place based on best evidence regarding how often blood sugars are checked, what the acceptable parameters are, and what interventions are required.

RNIBCLC

Specializes in Maternity.

I am in the process of doing that. I'm used to a more collegial atmosphere, physicians and nurses working together. Thanks for all of the responses. I am afraid I have a long uphill battle.

Both the American Academy of Pediatrics and the Canadian Paediatric Society have guidelines regarding serum glucose screening of newborns, both of which are available on line at no charge:

Adamkin, D. H. (2011). Postnatal glucose homeostasis in late-preterm and term infants.
Pediatrics, 127
, 575-579.
Postnatal Glucose Homeostasis in Late-Preterm and Term Infants

Aziz, K., & Dancey, P. (2004). Screening guidelines for newborns at risk for low blood glucose. Paediatrics & Child Health, 9(10), 723-729. Retrieved from
Screening guidelines for newborns at risk for low blood glucose | Position statements and practice points | Canadian Paediatric Society

The following is also available online at no charge:

Tin, W. (2014). Defining neonatal hypoglycaemia: A continuing debate.
Seminars in Fetal and Neonatal Medicine, 19
, 27-32.
http://dx.doi.org/10.1016/j.siny.2013.09.003

RNIBCLC

Specializes in Maternity.

Both the American Academy of Pediatrics and the Canadian Paediatric Society have guidelines regarding serum glucose screening of newborns, both of which are available on line at no charge:

Adamkin, D. H. (2011). Postnatal glucose homeostasis in late-preterm and term infants.
Pediatrics, 127
, 575-579.
Postnatal Glucose Homeostasis in Late-Preterm and Term Infants

Aziz, K., & Dancey, P. (2004). Screening guidelines for newborns at risk for low blood glucose. Paediatrics & Child Health, 9(10), 723-729. Retrieved from
Screening guidelines for newborns at risk for low blood glucose | Position statements and practice points | Canadian Paediatric Society

The following is also available online at no charge:

Tin, W. (2014). Defining neonatal hypoglycaemia: A continuing debate.
Seminars in Fetal and Neonatal Medicine, 19
, 27-32.
http://dx.doi.org/10.1016/j.siny.2013.09.003

Thank you

At my hospital, preterm and SGA babies are tested q2-3 hr for 24 hrs, and LGA babies and those born to type 1, 2 or GDM moms are tested q2-3 hr for 12 hrs. The last three blood sugars have to be above 45.

Elvish, BSN, DNP, RN, NP

Specializes in Community, OB, Nursery.

Our standing orders are to check glucose for 4000g regardless of gestation, anyone 45.

Our neos like sugars to be >60 after 24 hours, but the reality is we don't check too many sugars at that point.

When I took STABLE earlier this year (great class btw, highly recommend it), the NNP teaching it told us general consensus is that there is no general consensus for a certain number that is best for every infant. We probably miss asymptomatic hypoglycemia because we don't check every newborn randomly....but the babies are apparently fine. And some kids will crash no matter what you feed them but there is almost always something else behind it when that happens.

RNIBCLC

Specializes in Maternity.

I feel like I'm another planet. One particular MD is in the wrong century. I'm so frustrated trying to support breastfeeding with such outdated practice. Thanks for the info. At least I know I'm not crazy.

cayenne06, MSN, CNM

Specializes in Reproductive & Public Health. Has 10 years experience.

I've seen many breastfeeding relationships be damaged with ridiculous blood sugar protocols. This is one of my hulksmash issues. grrrr.

T-Bird78

Has 6 years experience.

My baby was born at 37 weeks 4 days, weighing in at an impressive 8# 6 oz, and his BS was checked frequently his first 24 hours then d/c. Is that normal? The nurse said it was because of his size. My first baby was 7# 3 oz and they never checked his (born 38 weeks 3 days). Just curious. Big baby's BS was always normal and he ate normally too, and I was not gestational diabetic with either one.

Elvish, BSN, DNP, RN, NP

Specializes in Community, OB, Nursery.

I can't speak to your specific situation but sometimes if we get a baby that weighs significantly more than expected (in other words, LGA) we suspect GDM that had a later onset and wasn't picked up at the traditional 28-week check.