Glucose Monitoring in the Healthy Newborn Clinical Pathway — Inpatient

Signs and Symptoms of Neonatal Hypoglycemia

Major Symptoms	Jitteriness Irritability High-pitched cry Apnea, cyanosis, irregular/rapid breathing Hypotonia Seizures
Symptoms That May be Present	Temperature instability, hypothermia Poor suck, refusal to eat

Risk Factors for Neonatal Hypoglycemia

Primary risk factor indicators to initiate glucose monitoring	Prematurity < 37 wks Post-term > 42 wks SGA, weight < 10^th percentile LGA, weight > 90^th percentile Infant of a diabetic mother Consider for maternal failure of 1 hr glucose test or unknown glucose testing results Family history of congenital hypoglycemia disorder Maternal medications Terbutaline within 1 hr of delivery Beta blockers Oral hypoglycemics Prolonged steroid use during pregnancy Suspected syndrome associated with hypoglycemia Beckwith-Wiedemann Turner syndrome
Additional risk factors noted by practitioner and may warrant initiation of glucose monitoring	Erythroblastosis fetalis Polycythemia Respiratory distress Suspected sepsis Midline defects Cleft lip/palate Microphallus Apgar < 7 at 5 mins Cord pH < 7.1 or base deficit more than 14 Cold stress Hypothermia (axillary temp < 97.3°F or 36.3°C) No prenatal care

Primary risk factor indicators to initiate glucose monitoring

Prematurity < 37 wks
Post-term > 42 wks
SGA, weight < 10^th percentile
LGA, weight > 90^th percentile
Infant of a diabetic mother
- Consider for maternal failure of 1 hr glucose test or unknown glucose testing results
Family history of congenital hypoglycemia disorder
Maternal medications
- Terbutaline within 1 hr of delivery
- Beta blockers
- Oral hypoglycemics
- Prolonged steroid use during pregnancy
Suspected syndrome associated with hypoglycemia
- Beckwith-Wiedemann
- Turner syndrome

Additional risk factors noted by practitioner and may warrant initiation of glucose monitoring

Erythroblastosis fetalis
Polycythemia
Respiratory distress
Suspected sepsis
Midline defects
- Cleft lip/palate
- Microphallus
Apgar < 7 at 5 mins
Cord pH < 7.1 or base deficit more than 14
Cold stress
- Hypothermia (axillary temp < 97.3°F or 36.3°C)
No prenatal care

SGA or LGA

May use Fenton growth chart with SGA < 10^th percentile and LGA > 90^th percentile.
For neonates born between 37 and 41 wks, < 2500 g and > 4000 g may be appropriate.

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.