1. 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 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

2. 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 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 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