Dear Friends,
Excuse my rant in advance. I am incredibly upset over a recent proposed 
change in our hospital's policy regarding definition and treatment of neonatal 
hypoglycemia. This is being done without even inviting comment from our LC's. It 
appears that there is a program called S.T.A.B.L.E. in which a sick newborn is 
stabalized for transport to a level III tertiary care center. Because that 
center for us recommends starting an IV if glucose levels are below 50, that will 
become our policy for ALL babies with levels below 50. Our standard for 
intervention (read- formula feeding) in the past has been below 40...some docs even 
allowed breastfeeding if levels were between 35 and 40. Please understand, I 
am not agaist an IV start for a baby requiring transport from our level II 
nursery to a level III as they are NPO and we will have the mom pump ASAP.

When the S.T.A.B.L.E. class was presented, I was not invited to attend as I 
am not a primary nurse in the nursery. (I did hear some nurses say 
afterwards..."Wait 'til Kathy hears this one!") Our supervisor was to have retired in 
November but they haven't been able to locate a replacement for her, even though 
they have been trying for nearly 6 months. It angers me that she is making such 
a huge step backwards just before someone else steps in to take her place. In 
the meantime, there is not yet a printed copy of the NEW policy, so some 
nurses have taken it on their own to bottle feed formula to babies whose glucose 
is "low". The most recent I heard of was 46.

Yes, I have given printed copies of the Academy fo Breastfeeding Medicine 
policy, the  WHO publication (60 pages) on hypoglycemia, and all the other 
significant publications that I could find. I have spoken to one of the co-chairs of 
the Pediatric department. So far, this issue has only been introduced at one 
of their meetings along with discontinuing the practice of rectal temperature 
checks and the use of the transcutaneous bili meter. Sadly, not one word of 
question, let alone protest was raised over this change. They did have rather 
animated discusion over the other 2 topics, however...sigh.

Please let me know if you have any understanding or experience in the 
S.T.A.B.L.E. program. TIA
Kathy Bowers, RN, IBCLC  proud mom of a blended family of 5 boys...now young 
men.

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