Inpatient Clinical Pathway for Glucose Monitoring
of the Healthy Newborn, 0-48 Hours of Age
- Related Pathway
- Newborn Persistent Hypoglycemia, N/IICU
Assess for Symptoms and Risk Factors for Hypoglycemia
Asymptomatic
WITHOUT Risk Factors
WITHOUT Risk Factors
Asymptomatic
WITH Risk Factors
WITH Risk Factors
No further action
Feed within 1 hr of life
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
- Consult Neonatology for management plan
- Consider IV Dextrose Treatment
Check Blood Glucose (BG)
30 minutes after feed
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 pumped/donor breastmilk, formula
- Consider IV Dextrose Treatment
Recheck within 1 hr of feed
Continue BG checks every 2-3 hrs pre-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
- Consult Neonatology for management plan
- Consider IV Dextrose Treatment
Check 2-3 more consecutive blood glucose
Goal BG
> 40 mg/dL for < 24 hrs of ageor
> 50 mg/dL for 24-48 hrs of age
- May stop checking BG
- Consider BG check at 24 hr of age
for SGA or late preterm infant - Review Endocrinology Consult Indications
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
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