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Date: | Fri, 7 Jan 2005 19:55:35 EST |
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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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