Inpatient Clinical Pathway for Glucose Monitoring
of the Healthy Newborn, 0-48 Hours of Age

Goals and Metrics
Neonatal Glucose Monitoring
Prevent Hypoglycemia
Assess for Symptoms and Risk Factors for Hypoglycemia
Asymptomatic
WITHOUT Risk Factors
Asymptomatic
WITH Risk Factors
Symptomatic
No further action
Feed within 1 hr of life
Check Blood Glucose (BG)
BG > 40 mg/dL
BG ≤ 40 mg/dL
  • Consider Neonatology consult
  • Identify other etiologies that
    cause symptoms
  • If risk factors present, check
    until 2-3 consecutive BG
    • > 40 mg/dL for < 24 hrs of age
    • > 50 mg/dL for 24-48 hrs of age
Check Blood Glucose (BG)
30 minutes after feed
BG > 40 mg/dL
BG 25-40 mg/dL
BG < 25 mg/dL
Check BG pre-feed (Q2-3 hr)
  • Apply gel and refeed
  • Breastfeed w/good latch
  • Give pumped/donor breastmilk if available
  • Consider formula supplementation
  • Suggested Feeding Volumes
  • Consult Neonatology
  • Apply gel and refeed
    • Consider pumped/donor breastmilk, formula
      as indicated
  • Consider IV Dextrose Treatment
Recheck within 1 hr of feed
Continue BG checks every 2-3 hrs pre-feed
BG > 40 mg/dL
BG 25-40 mg/dL
BG < 25 mg/dL
    • Apply gel up to 3 doses
    • Refeed, must give pumped breastmilk if available
    • And/or
    • Supplement with donor breastmilk or term formula
    • Consider 22 calorie formula
Check 2-3 more consecutive blood glucose
Goal BG
> 40 mg/dL for < 24 hrs of age
or
> 50 mg/dL for 24-48 hrs of age
BG 25-40 mg/dL
If BG < 25 mg/dL consult Neonatology
Recheck BG within 1 hr
Continue BG checks
every 2-3 hrs pre-feed
BG < 40 mg/dL ≥ 3 times
    • Consult Neonatology
    • Consider IV Dextrose Treatment
    • Consider 4th dose glucose gel
      to support infant during transfer to N/IICU
Further Management
Posted: May 2014
Revised: December 2023
Editors: Clinical Pathways Team