I am curious as to what other hospitals use as a normal newborn hypoglycemia protocol? I feel ours is a bit aggressive.
Here is our protocol.
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.
The parents hate it, we feel mean and the babies can't enjoy it--they pull their feet away whenever someone touches them.
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.
So sad. I understand doing what needs to be done, I just wish patients/people had more opportunity to make better informed decisions, in this sort of situation, and also regarding their general health. But maybe that's why I am interested in PH. :icon_roll
The last protocol we had was very reasonable and it seems to be the standard of care where most of you work! Yes, the poor babies' heels do resemble hamburger.
The docs have not been "able" to produce any evidence-based research on the benefits of these frequent glucose checks. I do know that there was one baby who had a glucose of 17 that "may have been prevented" had there been more frequent glucose testing. I think that babe was at high risk IUGR.
I worked in a NICU for 5 years prior to moving here, and we didn't even test that frequently in the NICU!!!! This is a well baby nursery.
I just don't get it.
Any good ideas on where I may be able to find good research to prove that the infants do not need this??
Heeeheeehee. Sorry. It's just that in my hospital, if the initial stick is low, the baby gets fed. If the pc stick is below 50, we (in the NICU) have to admit the baby.
At risk's get one shortly after birth, then 3 pre-feeds. They have to be over 40, if not (or if on the low side) we feed via mother's chosen method and recheck.
Just was reading this thread and we just changed our protocol to be heel stick , for the "at risk newborn" ,to be done 1 hour after birth, 2 hrs after birth and 3 hours after birth. The glucose level resulted is to be 50 or higher. Yes, we have had parents refuse.
I'm not sure what the hospital policy was, but when I had my little guy (okay, he was actually a fair sized guy, 8# 9 oz), they were doing heel sticks on him about every three hours as well once they let me have him; he spent over five hours in the nursery before they'd even bring him to me b/c of low sugars. They didn't stop checking his sugars until about 24 hours old. I'm not a baby nurse, so I don't know if it makes a difference or not, but I was not a gestational diabetic.
Out of curiosity, does anyone know if the fact that I had real milk in already instead of colostrum could have made any difference? Is there a significant difference in sugar content between the two? He was a great feeder. (And still is, if it's not locked up he'll eat it!)
We can do a blood sugar on pretty much anybody we are concerned about. Have found quite a few slow-to-warm, grunty, jittery, blue, floppy, or otherwise compromised kiddos with a lovely BG of 28 or something. Amazing how they pink up, warm up, and their tone is great after a feed. But our IDMs and LGA/SGA kids are the ones that we check no matter what.
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
Per our NNP orders, any newborn below 45 must be allowed to BF first, then we PC with a cup, trying to get at least 20ml of formula to stablize blood sugars, One more very important thing we do as a standard of care: Skin-to-Skin for all newborns on mom's chest. Studies have shown not only do these babies breastfeed much better, sooner, but sugars are much more stable, making it less necessary to continually stick the babies (ouch) and supplement with formula. Also, parent-baby bonding is wonderful this way. And finally, clearly, no one wants to have to start an IV for sugar stabilization. Really, skin-to-skin and deferring that bath for a few hours, or until sugars are stable should be the standard for all well newborns, but most especially those who are on glucose protocols.
My preemie son stablized well and fast, being skin to skin with either his dad or myself the entire time we were in the hospital. It's far better than sticks and formula, really!
Vida
129 Posts
So sad. I understand doing what needs to be done, I just wish patients/people had more opportunity to make better informed decisions, in this sort of situation, and also regarding their general health. But maybe that's why I am interested in PH. :icon_roll
V