Routine newborn blood glucose testing?

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Our nursery has been routinely performing a blood glucose test upon admission and in 2 hours. The majority of peds and GPs agree that this will diagnose and prompt intervention for the asymptomatic infants and prevent brain damage by quick treatment. One physician insists that only LGA, SGA and infants of gestational diabetic mothers are to be tested. Our standards and orders suggest routine screening at birth and in two hours whether at risk or not as well as PRN.

WHAT does everyone else do? Is there a national SOC ? Where would we find literature to support one or the other of these practices?

We are all very stressed when we forget and test his babies. And we need some data to support or delete our current practice. It would obviously cost less to only test those at risk babies as listed.

What do you think? Any help would be great!!!!

Thanks

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I don't know what or if AAP has guidelines for neonatal glucose screenings. We only do high risk babies or those who exhibit sx's of hypoglycemia. LGA,SGA, less than 37 wk. or more than 42 weeks, infant of DM mom per routine orders. We also (usually) screen those w/ low apgars, tachypnea, tachycardia, jittering, lethargy, or low temp's,babies who are/will be NPO, etc.

Honestly, I don't think we miss much and I really don't see the need for all babies to get a glucose. It may just be how I am used to doing things because I know a lot of places do glucoses on ALL babies. There is also some debate on treating asymptomatic glucoses in term newborns which are in the 35+ range. This has been going on for at least 10 years. (sorry for any other bad spelling/poor typing today)

I can't find anything from AAP. It looks like they might be coming out w/ a new position statement.An AAFP article does state that routine glucose screening in the healthy, term neonate is not indicated. http://www.aafp.org/afp/20001115/tips/14.html

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We do glucoses on all babies at birth and at 2 hours. I have seen many that never showed any signs of hypoglycemia but had a BS of 30 or so. We have standing orders that all the ped dr's have agreed upon so we don't have much of a problem with it.

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Specializes in Emergency.

Just a though.

Not being an OB/GYN nurse my only input is that its better to error on the side of doing one or two too many glucose tests than to miss a low BS. Coming for an ER environment its kind of like cardiac enzymes we would rather do one two many than to miss a heart attack. You find things sometimes where you least expect them.

RJ

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Specializes in Behavioral Health.

We do blood sugars on LGA, SGA,

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We never do "routine" anything. If the baby is healthy and has breastfed and has some fat stores and isn't showing any symptoms and doesn't have any risk factors, our docs would not be pleased that we poked them for a blood sugar. It isn't indicated.

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Specializes in Postpartum, Lactation.

We also only do SGA, LGA, GDM, pre/post term and those with symptoms. If the "routine" treatment for an asymptomatic hypoglycemic is po formula, I think that you are doing more harm than good in the long run. Those babies who are given formula early tend to be sleepy, poor breastfeeders.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
We never do "routine" anything. If the baby is healthy and has breastfed and has some fat stores and isn't showing any symptoms and doesn't have any risk factors, our docs would not be pleased that we poked them for a blood sugar. It isn't indicated.
thank you.
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Specializes in OB.
We never do "routine" anything. If the baby is healthy and has breastfed and has some fat stores and isn't showing any symptoms and doesn't have any risk factors, our docs would not be pleased that we poked them for a blood sugar. It isn't indicated.

Exactly. Why poke unnecessarily? These little babies get poked and prodded enough from PKUs and other bloodwork that may be needed. Our standard orders are to check glucose on any SGA, LGA, IDM, or on babies that show any s/sx of hypoglycemia during the transition period. We look for 4 good sugars before we stop checking. We encourage the mom to breastfeed if a baby is hypoglycemic or we'll give formula if the mom has clearly stated that she will not be breastfeeding.

We also do them PRN for temp instability, s&s of hypoglycemia, poor nursing, etc.

We do this as well.

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IMO, this is the problem with sending healthy babies to nurseries routinely.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

and why I believe in strict mom-baby rooming-in unless medical conditions preclude this. And, those are not common in well moms and babies.

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Specializes in NICU.

We don't do routine testing, either. LGA, SGA, IDM babies, stressful deliveries, symptomatic babies. After transition, we'll check a baby who isn't nursing well, to see if it's something to worry about.

We are happy if it's over 45mg/dl, otherwise we draw a stat blood glucose for correlation. We notify the doc when we get that result back.

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