Measure pre-feed blood glucose (BG) before 2nd feed (within 2 - 4 hours) and continue measuring ongoing pre-feed BGs. If potential symptoms of hypoglycaemia check BG at any time.
Observations should be performed at intervals as on the BEWS chart:
Tone (not floppy)
Temperature (36.5 - 37.4oC)
Respirations (<60 rpm)
Colour/perfusion (not pale/blue)
Level of consciousness (arouses)
Interest in feeding (not prolonged disinterest)
All infants with risk factors should be observed for efficacy of feeding in the maternity unit for a minimum of 24 hours after birth, irrespective of blood glucose levels
Pre-feed blood glucose monitoring should continue until there are three consecutive results ≥2.0 mmol/L. Feeding support should continue until mother and midwife are happy that effective feeding has been established.
INTERVENTION FOR BLOOD GLUCOSE LEVEL
Thresholds of blood glucose (measured on blood gas machine) requiring intervention (for babies in first 48 hours of life only):
<1.0 mmol/L in any baby at any time
<2.0 mmol/L in a baby at risk for hypoglycaemia
<2.5 mmol/L with abnormal clinical signs (this includes all infants with hypoxic-ischaemic encephalopathy)
What to do if blood glucose (measured on blood gas machine) is <1.0 mmol/L, or baby shows symptoms of hypoglycaemia with blood glucose <2.5 mmol/L (first 48 hours of life):
Immediately refer to paediatrician for intravenous 10% dextrose bolus 2.5 mL/kg, followed by 10% dextrose infusion at a volume appropriate to the day of life. Paediatrician should perform hypoglycaemia screen if possible, and infection screen.
If there is any delay in dextrose bolus, give 40% dextrose gel (200 mg/kg) or single dose IM glucagon (200 micrograms/kg, maximum 1 mg). These should be interim measure only, do not allow these to delay intravenous dextrose bolus.
Baby will be transferred to NNU.
What to do if one blood glucose (measured on blood gas machine) is 1.0 - 1.9 mmol/L (asymptomatic, first 48 hours of life):
40% buccal dextrose gel (see box below for doses) should be administered by a registered healthcare professional. Draw up the correct volume of gel using a 2.5 or 5 mL oral syringe. Dry the oral mucosa with gauze, gently squirt the gel onto a gloved (latex free) finger and massage into the mucosa of the inner cheek. Larger doses may be split and administered to both cheeks.
If baby does not feed at the breast and no colostrum/EBM is available give infant formula by cup 10 – 15 mL/kg for a single feed.
If there is a second occurrence of BG 1.0 - 1.9 mmol/L then a second round of dextrose gel and feeding can be given but paediatrician should be informed urgently. Do not use two doses of buccal dextrose without referring to paediatrician for immediate assessment. A paediatrician may start a feeding plan after the second occurrence of BG 1.0 - 1.9 mmol/L
Guideline 447.6 7 of 9 Uncontrolled if printed
What to do if there are three blood glucose measurements 1.0 - 1.9 mmol/L (first 48 hours of life):
a) Refer urgently to paediatrician for NNU admission, hypoglycaemia screen, infection screen and need for nasogastric tube or intravenous dextrose.
b) If there is any delay in paediatric assessment, give further 40% buccal dextrose gel and support mother to breastfeed and/or give colostrum/EBM while awaiting assessment.
DISCHARGE FROM HOSPITAL:
Babies in ‘at risk’ categories should not be transferred to community care until they are at least 24 hours old, and not before healthcare professionals are satisfied that the baby is maintaining blood glucose levels and is feeding effectively.
Observations should be performed at intervals as on the BEWS chart:
Tone (not floppy)
Temperature (36.5 - 37.4oC)
Respirations (<60 rpm)
Colour/perfusion (not pale/blue)
Level of consciousness (arouses)
Interest in feeding (not prolonged disinterest)
All infants with risk factors should be observed for efficacy of feeding in the maternity unit for a minimum of 24 hours after birth, irrespective of blood glucose levels
Pre-feed blood glucose monitoring should continue until there are three consecutive results ≥2.0 mmol/L. Feeding support should continue until mother and midwife are happy that effective feeding has been established.
INTERVENTION FOR BLOOD GLUCOSE LEVEL
Thresholds of blood glucose (measured on blood gas machine) requiring intervention (for babies in first 48 hours of life only):
<1.0 mmol/L in any baby at any time
<2.0 mmol/L in a baby at risk for hypoglycaemia
<2.5 mmol/L with abnormal clinical signs (this includes all infants with hypoxic-ischaemic encephalopathy)
What to do if blood glucose (measured on blood gas machine) is <1.0 mmol/L, or baby shows symptoms of hypoglycaemia with blood glucose <2.5 mmol/L (first 48 hours of life):
Immediately refer to paediatrician for intravenous 10% dextrose bolus 2.5 mL/kg, followed by 10% dextrose infusion at a volume appropriate to the day of life. Paediatrician should perform hypoglycaemia screen if possible, and infection screen.
If there is any delay in dextrose bolus, give 40% dextrose gel (200 mg/kg) or single dose IM glucagon (200 micrograms/kg, maximum 1 mg). These should be interim measure only, do not allow these to delay intravenous dextrose bolus.
Baby will be transferred to NNU.
What to do if one blood glucose (measured on blood gas machine) is 1.0 - 1.9 mmol/L (asymptomatic, first 48 hours of life):
40% buccal dextrose gel (see box below for doses) should be administered by a registered healthcare professional. Draw up the correct volume of gel using a 2.5 or 5 mL oral syringe. Dry the oral mucosa with gauze, gently squirt the gel onto a gloved (latex free) finger and massage into the mucosa of the inner cheek. Larger doses may be split and administered to both cheeks.
If baby does not feed at the breast and no colostrum/EBM is available give infant formula by cup 10 – 15 mL/kg for a single feed.
If there is a second occurrence of BG 1.0 - 1.9 mmol/L then a second round of dextrose gel and feeding can be given but paediatrician should be informed urgently. Do not use two doses of buccal dextrose without referring to paediatrician for immediate assessment. A paediatrician may start a feeding plan after the second occurrence of BG 1.0 - 1.9 mmol/L
Guideline 447.6 7 of 9 Uncontrolled if printed
What to do if there are three blood glucose measurements 1.0 - 1.9 mmol/L (first 48 hours of life):
a) Refer urgently to paediatrician for NNU admission, hypoglycaemia screen, infection screen and need for nasogastric tube or intravenous dextrose.
b) If there is any delay in paediatric assessment, give further 40% buccal dextrose gel and support mother to breastfeed and/or give colostrum/EBM while awaiting assessment.
DISCHARGE FROM HOSPITAL:
Babies in ‘at risk’ categories should not be transferred to community care until they are at least 24 hours old, and not before healthcare professionals are satisfied that the baby is maintaining blood glucose levels and is feeding effectively.
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