Newborn Hypoglycemia Protocols?

SewHeather · Nov 11, 2008

ours is very similar, except when we have 2 consecutive readings above 45, we can discontinue to heel sticks unless we have any reason to recheck it, ie jitteriness, unwilling to eat, lethargy, etc... Checking every three hours after a few good reasings seems a little over the top, I would hate having to stick a baby that many times.

rn/writer, RN · Nov 11, 2008

Our at-risk newborns are checked about twenty minutes after birth. We encourage early breastfeeding. Depending on the reading, bottle-fed babies may also eat soon.

The goal is to have two consecutive readings > 45. Heel sticks are done ac and one hour or longer after a feeding until we get the two normal readings. Usually we are done by the time the kiddo is about four hours old. This saves them 4-6 sticks over your system. Yikes!

Once the two good readings are obtained, we don't do any more dexis unless there is something else that would warrant one--abnormal temp, lethargy, jittery behavior, etc. Your protocol does seem overly aggressive.

It would be interesting for your unit to keep track of how many newborns went on to have problems after two consecutive normal readings. If you found that this was highly unusual and that it was accompanied by some other indicator such as lethary or jitteriness that would cause you to do a dexi anyway, perhaps such evidence would persuade the top dog neonate to back off a bit and let sleeping babies lie.

nurseinnh · Nov 11, 2008

ours is very similar, except when we have 2 consecutive readings above 45, we can discontinue to heel sticks unless we have any reason to recheck it, ie jitteriness, unwilling to eat, lethargy, etc... Checking every three hours after a few good reasings seems a little over the top, I would hate having to stick a baby that many times.

That's the way it used to be before they changed the protocol. We have all asked the pedis to provide us with the literature that supports this new one. It has been a rough adjustment. Normally, we do vital signs on any at risk infant q4 until discharge...So we end up doing vitals q3 to cluster them with the glucose so as not to disturb them more than we have to. The babies we are most concerned about (with good reason) are the IUGR or twin gestations. But under the new protocol, we are poking the babies before feedings and then the poor things are completely worn out and won't eat! :banghead:

Elvish, BSN, DNP, RN, NP · Nov 11, 2008

We do heelsticks on at-risk babies at 1, 2, and 4 hours old. If those are all normal, we stop. If one of those is low, we feed them (or they breastfeed) and recheck in an hour. If the last one (or the 4-hr one, whichever is later) is normal, we stop. Q3 sounds a bit over-the-top.

SmilingBluEyes · Nov 11, 2008

We do three consecutive sugar checks , prior to eating. If all 3 are stable (we prefer above 45) then we do one more at 12 hours age and again, a final one at 24 hours. IF sugars are below 45, we do them more often, PC cup feeding formula on breastfeeding infants who "ride the line" continually, until they settle in the 50s.

mom2michael, MSN, RN, NP · Nov 12, 2008

Our "at risk" babies get one shortly after delivery. If it's below 40, we feed them and check again in 1 hour, if it's OK then it's one more check before their next feed and then we just monitor them if that one was OK. If s/s start to appear, then we can always recheck them otherwise we just encourage frequent feedings (either breast or bottle) and really stress to the parents that includes waking up the baby to make them eat.

I think your policy is a bit excessive (this is coming from me, the RN who works in a place that is over the top excessive regarding infants :rotfl:)

Vida · Nov 12, 2008

If that was my baby I'd refuse THAT many sticks! Geeze - poor little guys!

nurseinnh · Nov 12, 2008

If that was my baby I'd refuse THAT many sticks! Geeze - poor little guys!

We have only had a couple of parents refuse....one set of parents were doctors themselves.

Most parents just go with the flow, they believe that "we have to do what we have to do."

I think it is pretty excessive as well.

Conejita, BSN · Nov 12, 2008

ours is very similar, except when we have 2 consecutive readings above 45, we can discontinue to heel sticks unless we have any reason to recheck it, ie jitteriness, unwilling to eat, lethargy, etc... Checking every three hours after a few good reasings seems a little over the top, I would hate having to stick a baby that many times.

This is exactly the protocol we have on my unit.

rn/writer, RN · Nov 12, 2008

If an infant is at "high risk" for hypoglycemia (GDM, LGA or SGA) we need to check a glucose one hour after birth and then again two hours after birth. If either is below range (below 45), then we feed the infant and check glucose again. IF the second glucose is within "normal limits" (over 45) then we continue to check the baby's glucose via heel stick every 3 HOURS until 24 hours of age--even if the glucose is 60s-70s the whole time.

That's approximately ten sticks in 24 hours. The kids' heels must look like pin cushions. I'm all for testing when necessary, but this really does seem excessive. Then you add in another stick for the state screen and Yow!

This could actually represent a fair amount of blood loss in a smaller infant.

I'd get your manager to press the docs for justification for so much testing. In my book, they'd have to have some mighty compelling evidence to back this up.

SmilingBluEyes · Nov 12, 2008

I agree with Miranda----you are actually committing a sort of blood-letting in the way you do this. It could present a problem. And it is very unnecessary.