Newborn blood glucose sticks

Published

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

Up Vote Up Vote ×
Specializes in nursery, L and D.

At my last hospital it was q2 x 4, if mom GDM, baby over 9-9, under 5-0, over 42 weeks, or under 36 weeks, or if s/s of hypoglacemia ob. If all bs were over 40, d/c after #4.

Up Vote Up Vote ×
Specializes in Community, OB, Nursery.

We check everybody 8lb 13oz or over, everybody 5+8 or under, everybody whose mom had GDM or preexisting DM, floppy/jittery kids, and it's up to individual nurses if someone just doesn't look right.

Our protocol is at 1hr, 2hr, and 4hr old. If those are all ok, that's it unless they give us reason for concern. And of course, any time we feed someone for a low bg we check bg again 30-60 min after feeding. Anything above 40 is ok for us.

Up Vote Up Vote ×

Weightwise, we do kiddoes over 9# and under 6#. Other criteria would be temperature issues, lethargy, delivery distress, and mom with hx of any kind of diabetes. Also babies over 42 weeks and under 37 weeks. Once we get two in a row over 40 we stop unless there is a compelling reason to continue. We test prior to a feeding so the sticks are 2-3 hours apart.

We can also do a blood sugar any time we feel there is a reason to do so, especially after a high or low temp. I check babies who need to go under the warmer lights as low temp can be both a cause and an effect of low bg. Those little ones can bottom out fast.

If we have cause for concern, we can get a stat bg at any time.

Up Vote Up Vote ×
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

Any infant over 40 weeks? Is that a typo? If not that seems way over the top to me...

Up Vote Up Vote ×

LGA, SGA, infant of a diabetic mother, less than 37 weeks or greater than 42, 5 min. apgar = 7 or less, admit temp less than 97.0*R, all level II admits -- get bedside glucose tests every 2 hours x 3 total.

If less than 40, send serum, give D5W PO (or call doc if RDS & can't eat - for OG or IV orders) and repeat about 30 -40 min after feed. Doc is notified (after resolved) and then may order extended tesing if desired. We only have one doc that does this consistently

Low temp after leaving transition (later in mom's room, etc.) gets one check - if ok, then no more.

Up Vote Up Vote ×
Specializes in OB L&D Mother/Baby.

Our pedis order bloodsugars on a case by case basis. Your protocol does seem like a lot. If I was a mom of a 9lber who had three normals I certainly wouldn't want my kid to keep getting poked. But then again I had 2- 10 lb babies and both had two sugars and that was that, I didn't have a history of gd though.

For a diabetic mom we generally do sugars q1hr x 3. Then some pedi's d/c them and others have us continue to do them ac for 24 hrs... Get's to be a bit much if the kid wants to eat constantly. But our pedis are also very good about having a call at home to say "all of the sugars have been fine and he wants to nurse every hour, can we d/c sugars" usually they say yes without a hitch.

Up Vote Up Vote ×
Specializes in L&D, Antepartum.

We do BS for over 8lbs, under 5lbs 8oz, less than 37 weeks, over 42 weeks. If its 40 or >, we don't do another. If mom is GDM, we do one BS, if normal another 30mins later. If any are abnormal, mom BF or bottle feeds 15ml, then do another BS 30mins after feeding. It goes on from there if there are more abnormals but its extensive. Its also up to the RN's discretion if baby seems symptomatic.

OP: Your policy does seem extensive. If its normal and there are no S&S then why keep checking? Poor kid doesn't need to be stuck so many times without symptoms.

- N

Up Vote Up Vote ×

I appreciate all the replies. Yes, I feel our policy is too much; there is simply no reason to get 8-9 blood sugar checks on an infant who is healthy, nursing/taking a bottle well, and whose previous checks were normal!

I am new, so I don't want to step on any toes. But I did approach someone in the nursery today, and was relieved to find that they are already in the process of gathering data in order to update the protocol. The nursery nurse said our protocol hadn't been updated in over 15 years. Lovely.

As soon as I'm over my 90 day orientation, I can "volunteer" (ie, if I ever want a raise, I need to do this) for various committees; I'm hoping to get on the one that evalutates and updates the department protocols. A lot of our protocols seem old and out of date. I'll probably be on here a lot, asking about different practices for comparison. I appreciate everyone's input!

Jean

Up Vote Up Vote ×
Specializes in Midwifery.
We check everybody 8lb 13oz or over, everybody 5+8 or under, everybody whose mom had GDM or preexisting DM, floppy/jittery kids, and it's up to individual nurses if someone just doesn't look right.

Wow Reeeally every 8lb 13oz plus.......

I thought ours was overkill!:monkeydance:

Neonatal hypoglycemia is not something I'm that up on, this is something I've referred to in the past, bit old now tho'......

http://www.who.int/reproductive-health/docs/hypoglycaemia_newborn.htm

I do know tho that evey bloody dr seems to have different ideas on who should be screened and what the minimum should be.

Up Vote Up Vote ×
Specializes in Postpartum, LDR.

At our hospital, it is over 4000 grams or under 2500 grams, less than 37 weeks or greater than 42 weeks, or infants of diabetic mother. We do blood sugar 2 hours pc (after feeding) for non diabetic mother, 1 hour for diabetic mother. Than we do 2 ac blood sugars. If the blood sugar is below 40, we do a blood serum, feed and check in an hour.

Up Vote Up Vote ×
Specializes in postpartum, nursery, high risk L&D.

we do sugars on admission, at 1hr & 4hrs for babies

Up Vote Up Vote ×
+ Add a Comment