Hypoglycemia in the NICU

NICUNurseEliz · Dec 20, 2016

Our only set policy for nursing is that we draw a whole blood glucose if the glucometer gives a reading for less than the minimum value that it's calibrated for. Other than that, we work closely with our NNPs/PAs/neos with reporting the values and they make decisions from there (I know they have an algorithm that they vaguely follow). I know they consider how many hours old the baby is, FT vs PT, risk factors (preterm, IDM, IUGR, sepsis), the baby's ability to feed, etc. Their decisions can then include feeding the baby, 2ml/kg D10 bolus, start IV fluids, or increase GIR on existing fluids.

RNtoNNP, BSN, DNP, APRN · Dec 23, 2016

Our policy is that in the first 24 hours an infant's blood sugar has to be at least 40 and after 24 hours it has to be at least 50. For admits, we get a blood sugar at 30 minutes of age and then continue to get one every 30 minutes until stable (usually they like it stable above 50, but technically it can be just above 40). If the infant has a low sugar, it is up to the practitioner whether they will just feed the infant or start an IV. It depends on age of the infant and the infant's condition. Typically if the infant is less than 35 weeks, we can anticipate that they will be getting an IV regardless. Aside from admission blood sugars, we also get a sugar 1-2 hours after we change the rate on the IV or change the IV glucose concentration. We very rarely draw a serum glucose level unless the infant has chronic hypoglycemia that we are having trouble controlling.

babyNP., APRN · Dec 23, 2016

Unfortunately, there is no true evidence based practice that says what exact levels are too dangerous for newborn (well, I suppose unreadable :) ) Your question also needs to be tailored to- is this a term newborn? Preterm? Very sick? How low is the sugar? There won't be a one size fits all, because some babies could just be directed to immediately bottle/NG feeding whereas others need a D10 bolus of 2 ml/kg followed by a continuous D10 IV infusion.

Semper_Gumby · Dec 27, 2016

Not a NICU nurse, I worked well baby nursery at a hospital which also had a small level II nursery that took up to 32 weeks. We drew a blood sugar on all babies within two hours of life and another approximately two hours later. If both were >40 mg/dL we didn't have to do any more. If between 30-40, we'd give D5W (10-20 cc's, generally however much you could get baby to take) by bottle (though breastfeeding babies we'd try to get on the breast first before resorting to a bottle). If 20-30 we gave D10W. If it was below 20 we were supposed to get orders for an IV. We rarely had to resort to that though. Once a baby had two good blood sugars we'd stop checking unless the doc wanted otherwise. All babies below 35 weeks automatically got an IV and admitted to the special care nursery. Usually we'd run IV D10W at 80 or 100 mL/kg/day. If we had really preterm babies we usually did the same to get them ready to ship out to a NICU.

If a baby was tachypneic with a low blood sugar, sometimes we'd drop an OG for an oral D5 or D10 bolus but often they got IV's and a special care admit.