• Newborn Nursery QI Committee. Neonatal hypoglycemia: initial and follow up management. Portland (ME): The Barbara Bush Children's Hospital at Maine Medical Center; 2004 Jul. 4 p.

This is the current release of the guideline.

Newborn hypoglycemia

Diagnosis
Evaluation
Management
Screening
Treatment

Family Practice
Pediatrics

Advanced Practice Nurses
Nurses
Physician Assistants
Physicians

To present guidelines for screening and management of newborns at risk for, or diagnosed with, hypoglycemia

Newborns at risk for hypoglycemia

Screening/Diagnosis/Evaluation

1. Assessment using screening criteria (refer to "Major Recommendations" field)
2. Measurement of blood glucose levels

Treatment/Management

1. Early feeding
2. Supplementation (oral, nasogastric gavage, intravenous [IV])
3. Rechecking blood glucose after interventions
4. Weaning from supplementation
5. Referral to specialists as necessary

Not stated

Searches of Electronic Databases

The following databases were searched: CINAHL, MEDLINE, and OVID.

Not stated

Subjective Review

Not applicable

Review

Not stated

Not stated

Not applicable

A formal cost analysis was not performed and published cost analyses were not reviewed.

Not stated

Not applicable

The major recommendations for management of hypoglycemia are provided in the form of three algorithms for Newborn Hypoglycemia General Information, Neonatal Hypoglycemia IV Glucose Weaning, and Neonatal Hypoglycemia Feeding.

General Information

Definitions

• Infants <24 hours of age: blood glucose levels should be consistently >45 mg/dL
• Infants >24 hours of age: blood glucose levels should be consistently >50 mg/dL

Screening

Data suggest subtle neurologic findings in asymptomatic infants with persistent hypoglycemia. Thus, a conservative approach to screening high-risk infants has been adopted by most centers.

High-risk infants who need screening for hypoglycemia in the first hour of life include:

• Newborns >4 kg or <2 kg
• Large for gestational age (LGA) >90th percentile, or small for gestational age (SGA) <10th percentile, or intrauterine growth restricted infants
• Infants born to insulin-dependent mothers or mothers with gestational diabetes
• Gestational age <37 weeks
• Newborns suspected of sepsis or born to mother suspected of having chorioamnionitis
• Newborns with symptoms suggestive of hypoglycemia: jitteriness, tachypnea, hypotonia, poor feeding, apnea, temperature instability, seizures, lethargy

High-risk infants are automatically screened via the newborn admission orders either every hour repeated three times (q1 x 3) (infant of diabetic mother or <2 kg) or every three hours repeated twice (q3 x 2) (all other high-risk scenarios).

Infants who also may need screening include:

• Significant hypoxia, perinatal distress, or five-minute Apgar <5
• Infant with mother on terbutaline, beta-blockers, or oral hypoglycemic agents
• Infant with isolated hepatomegaly (rule out glycogen storage disease [GSD]); microcephaly; anterior midline defects; gigantism
• Infants with macroglossia or hemihypertrophy (rule out Beckwith-Wiedemann Syndrome)
• Infants you suspect have an inborn error of metabolism

General Considerations

• All of the newborns listed under "Screening" will need early feedings initiated--either breast or bottle.
• Some of these infants will need supplementation via oral (PO), nasogastric (NG) gavage, or intravenous (IV) route.
• Abnormal glucose values need to be followed by rechecking blood glucose levels after interventions.
• Remember to follow blood glucose levels any time you change an intervention (e.g., transitioning from supplementation with formula to exclusively breast feeding).
• Infants with a respiratory rate >60 may need NG gavage feedings or IV placement.
• Infants that are not responding to your intervention may have other issues (sepsis, inborn errors of metabolism, or endocrine problems). Consider Neonatology consult to assist with diagnosis.
• If an IV is necessary for management, wean slowly after PO feeds are established. See weaning algorithm for management options.
• Contact Neonatology if the patient has two or more abnormal blood glucose values despite interventions or if greater than 120 cc/kg/day is necessary to maintain euglycemic state.

Algorithms are provided in the original guideline document for:

• Newborn Hypoglycemia General Information
• Neonatal Hypoglycemia IV Glucose Weaning
• Neonatal Hypoglycemia Feeding

The type of supporting evidence is not specifically stated for each recommendation.

• Appropriate screening for and management of hypoglycemia in newborns
• Decreased potential long-term sequelae of unrecognized, prolonged hypoglycemia
• Shorter length of stay because of earlier recognition

Not stated

Algorithms are not intended to replace providers' clinical judgement or to create a single protocol. Some clinical problems may not be adequately addressed in this guideline. As always, clinicians are urged to document management strategies.

Educational sessions and skills fair on guideline implementation; distribution of management guidelines to physician staff with admitting privileges to the newborn nursery

Getting Better

Effectiveness
Timeliness

• Newborn Nursery QI Committee. Neonatal hypoglycemia: initial and follow up management. Portland (ME): The Barbara Bush Children's Hospital at Maine Medical Center; 2004 Jul. 4 p.

Not applicable: The guideline was not adapted from another source.

2004 Apr

Barbara Bush Children's Hospital at Maine Medical Center - Private Nonprofit Organization

The Barbara Bush Children's Hospital at Maine Medical Center

Newborn Nursery QI Committee: Hypoglycemia Guideline Work Group

Work Group Members: Kelley Bowden, RNC, NNP, Perinatal Outreach Education Coordinator; Barbara Boyle, RN, Project Manager, Center for Performance Improvement; Brian Youth, MD, FAAP, Medical Director Newborn Nursery; Peter J. Marro, MD, Neonatologist; Kim Durost, RN, Nursery Staff Nurse; Beth Bejcek, RN, IBCLC, Lactation Consultant; Aida Stevens, MSN, RN, Nursing Director, Family Birth Center; Janet Oliver-Palanca, RNC, Unit Based Educator, Family Birth Center; J. Peter Chingos, MBA, Manager of Data Analysis, Center for Performance Improvement; Jeff Gregory, Data Analyst, Center for Performance Improvement

Not stated

This is the current release of the guideline.

None available

None available

This summary was completed by ECRI on June 3, 2005. The information was verified by the guideline developer on July 6, 2005.

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.