What's your protocol for low bld sugar? more...

SmilingBluEyes · Oct 3, 2004

I would have to dig out our protocols/algorithms to get you specific wording but here is a sketch of what we do:

Infants who are tested (accuchecked) for glucose levels routinely are:

small for dates (SGA), Large for dates (LGA), infants of diabetic moms, Meconium-stained infants, Stressed infants (poor strips with repeated decels), Symptomatic infants (jittery, lethargic, poor temp control, etc), infants at risk for infection (GBS/sepsis, mom with high fever in labor) and infants who are distressed after birth.

If accucheck is less than 40, we repeat immediately. If still less, we get STAT lab glucose-- and in the meantime, treat by immediate breastfeed (if able) or with bottle feed of formula (if mom unable), provided physical condition of infant does NOT prohibit PO feeds.

If lab glucoses come back less than 40 and persist despite feeding and warming we start IV and call pediatrician or NNP for further orders. Usually, this means bolusing of D-10 solution is begun right away after IV access is established. After bolusing, the glucoses are rechecked and re-bolusing may be indicated if persistent low sugars exist. It may require our changing the fluid to D-12 if the sugars are still low, despite treatment with D-10. If these conditions are persistent, PO feeds are withheld until the problem can resolved and infant stabilized.

If sugars begin to stabilize, and conditions allow, we watch them closely and allow breastfeeding with supplemental cup feeds of formula, as needed. Breastfeeding is ALWAYS done first and foremost. Cup/bottle feeds are only done as needed, if bf going poorly or infant fails to gain weight. We also use SNS systems to aid in breastfeeding for moms----all these things can be done even if a gavage tube is in place. We make every attempt to establish breastfeeding ASAP in our couplets.

The protocol is much more complicated than this; it's a virtual algorithm that tells us what to do at each juncture. But you get the idea here, I think. Hope this helps!

deb

palesarah · Oct 3, 2004

I'd have to check our policy to say for sure, but overall our protocol is similar to Deb's. We only routinely check infants of diabetic mothers, SGA infants, premature/preterm, and LGA infants with risk factors such as high maternal GTT. And of course any infant that is symptomatic is checked.

mitchsmom · Oct 4, 2004

That's wonderful, thanks! I think that is just what my teacher wanted me to seek out. :)

SmilingBluEyes · Oct 4, 2004

Good luck! Hope it helped!