IMHO, glucose screens for asymptomatic babies tend to be torture for the babies, families, and nursing staff. Our hospital's protocol for treating hypoglycemia in the neonate is sort of "breastfeeding neutral". The protocol requires screening for a variety of reasons. (We do a LOT of glucose screens.) The protocol states that a lab confirmation must be done for results less that 40. The lab may take up to 30 minutes to come draw a STAT blood glucose. We nurses feed (or have the mother breastfeed) the asymptomatic baby ASAP (As Soon As Possible). Of course, this means that we are not getting a confirmation of the glucose screen we just did, since the baby has eaten. Very few confirmations indicate "hypoglycemia". If the confirmation is OK, we just keep observing and feeding and notify the doctor on rounds. If not, we immediately call the pediatrician. The doctors vary in their recommendations. Most recommend formula as a supplement. A few prefere 5% glucose water. Some say to just keep breastfeeding the asymptomatic baby with a glucose screen between 30 and 40. When our protocol changed from performing the glucose screens before feedings to doing the screens at certain time intervals, the incidence of "hypoglycemia" declined. The neonatologist wants all breastfeeding babies supplemented, but he is not every baby's pediatrician. One family did not want supplements, so the neonatologist ordered glucose screens to be done and the baby supplemented if below 50. The two results I obtained that afternoon were 53 and 56 (3 hour intervals). If the person who wrote the protocol to supplement with formula still has power, will research findings change anything? Our hospital's changes came about when "clinical pathways" were being developed and one person did not "run the show". Becky Engel, RN, IBCLC Athens, GA