NBN Hypoglycemia Protocol April 2010 Is the baby Symptomatic? Irritable, jittery, seizure-like activity, lethargy, hypotonia, apnea, respiratory distress, sustained rectal temp <36.5 or >38, poor suck/refusal to feed, cyanosis or poor perfusion Yes No Does the baby have Risk Factors? • LGA / SGA • Meds • Mat. Diabetes—any type (terbutaline, beta blkr, oral hypoglycemic) • Suspected infxn./Mat. chorio • Preterm (<37 wks) • Perinatal distress (5 min Apgar ≤ 7, cord pH <7.14, PPV req’d.) ACTION: Check accucheck NOW Go to page 2 for management Yes No Feed within first hour after birth No routine glucose checks required Formula baby Breastfeeding baby Baby should receive 15-30 ml by bottle within first hour Mother available within first hour Yes No Put baby to breast– observe latch, express drops into mouth, massage breasts Baby asymptomatic ACTION: Check accucheck at one hour postnatal Page 1

ACTION: Check accucheck Page 2 ACTION: Check accucheck Glucose <25 Glucose 25 – 39 Glucose ≥ 40 Page HO or NP Send STAT serum glucose to lab Page HO or NP Send STAT serum glucose to lab Check accucheck before next feed Formula fed babies: should receive 15-30 ml of formula by bottle Breastfed babies: should be put to breast – include observed latch with breast massage during the feeding and/or hand expression of drops into babies mouth (for a C/S this should occur in PACU) If cannot be reunited with mom, fingerfeed 15-30 ml of formula and then teach pumping or hand expression and set up any equipment. Mother should be instructed to pump/express for 15 minutes for every time infant is supplemented. NOTE: IF 2nd time thru cycle, i.e. more than one glucose <40, fingerfeed as much as baby will safely take (ad lib) ≥ 40 stop checking unless develops symptoms Symptomatic (defined above) Asymptomatic Attempt IV or call NICU team to place IV STAT Criteria for Transfer to ICN Inability to PO safely or unable to take adequate volume with glucose <40 Full PO feeding (at least 30-45ml q 3hrs) per protocol and glucose remains <40 for >3 feedings in 12 hours period -OR- Continues to be symptomatic or unable to PO after D10W bolus If unable to place IV, call NERT If successful, give IV bolus 2 ml/kg of D10W Sx or unable to feed-- Notify HO or NP See Criteria for transfer Check accucheck 30 mins – repeat cycle A-Sx PO Feed