I am new to posting to lactnet although I have been a lurker for quite a
while. I am an LC in a community hospital that has about 250 births a
month. I have worked at this hospital for 15 years as a postpartum and
nursery nurse, and as the LC for the past 6 years. We have LC coverage 5
1/2 days a week. We have a high epidural and cesarean rate.
Recently our neonatologist changed our hypoglycemia policy in response to a
April Pediatrics Journal article recommending that the lowest acceptable
safe blood sugar levels for a newborn is 50. A heelstick sugar is taken if
an infant falls in the established risk category. If it is below 50, oral
D10 (3 cc per k) is given followed by "as much formula as the infant will
take". D/sticks are done before feedings and if it falls below 50 again,
the process is repeated. If it falls a 3rd time the baby is admitted to
NICU for IV therapy of D10, always followed by ABM. The nurses are scared
to let the baby nurse before giving the ABM because if he doesn't nurse
enough (most of the babies are very sleepy, and now very full), then it may
drop and he will have to go to Intensive Care.
Since this policy has been initiated, about 1 week, over 1/2 of the babies
in our nursery, both breast and bottle, vaginal or cesarean birth, are
going through the hypoglycemia protocol. Some days there are only 2-3
babies in newborn and they are being supplemented trying to avoid the NI
admission. Much of the time the sugar ranges around 40 to 50.
I won't even go into the ENORMOUS STRESS and frustration this has caused
the staff, myself, and most importantly the mothers and babies. We are
reviewing all of our thermoregulation practices, Mom's IV's in labor, etc.
Babies are born in an LDR and are kept with the mother (not always skin to
skin), until the mother is moved to postpartum.
Does anyone else have this as a new protocol? Any ideas why we cannot keep
the sugars above 50?, assuming the baby is warm. (I know, they are not
getting any colostrum!!) Does anyone know if there is
any studies on Mom's getting hours of Lactated Ringers in labor. Do
epidurals affect sugars? As frustrating as it is for me to stay working in
this environment, I want to assist the management to get to the bottom of
this problem and quickly come to a better situation.. TIA for any insight
or information anyone can give me.
Dianne Veatch
RN LCCE IBCLC
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