I am currently working on an OB unit as an RN as well as a Lactation
Consultant (IBCLC).  This is a job change from a University setting and has
been a real challenge.  The hospital I now work at is in a relatively
isolated community in Washington State.  It has about 130 beds and the
OB unit does approximately 1200 births a year.  Updating has been my
greatest challenge; helping the nurses and physicians, as well as the
policies be more breastfeeding friendly is my passion.  I am currently
working on the "Hypoglycemia Policy" which presently directs nurses to
supplement with 5% Dextrose Water when the blood sugar (tested per
accu-check) is below 40. It is common for a nurse to give a bottle of
glucose water before the infant has ever been put to breast.

I have read many articles and books on this subject and have found very few
answers. As a result of recent studies and improved technology, the
parameters for diagnosing hypoglycemia seem to be getting higher (40-45
instead of 30-40). I realize we need to allow for rebound when only giving
glucose water, but if giving formula to a breastfed infant, we counter-act
some of the benefits of the breastmilk, or colostrum.  Of counse, the best
way to handle hypoglycemia is to prevent it with early breastfeeding and
decreased stress to the infant; but, alas, that does not always happen!
(another project I am working on) We often have hypoglycemic infants whose
mothers want to breastfeed but infant cannot get a successful latch (for
various reasons) and mother has not or cannot pump an appreciable amount of
colostrum.  It is a dilema--how to address the hypoglycemia and yet maintain
the benefits of breastfeedng. We do not have donor milk available.

Any information or suggestions would be appreciated.  I would especially
like to know how other institutions are handling this problem, and what
their policy states.  Are you using care maps or alga-rythums (sp?), and do
the staff think they are helpful?  Additional information would be helpful,
ie:  size of institution, number of deliveries per year, parameters of
determining the diagnosis of hypoglycemia (blood sugar of 30-40, or above
40, etc.), and admission protocol of blood sugar testing for high risk
infants.

This information can be sent to my private E-mail ([log in to unmask]) or
posted, where it might help other people with similar problems.

Thank you again for your help--reading Lactnet is what keeps me going!

Elayne Clubb RN BSN IBCLC

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