Hi  Kathy,  I hope my post is not too late, I am just now catching up on my
Emails.

Several years ago (1997) our  hospital presented this program.
I believe I still have my original copy.  Yes I do.  I pulled it out to look
at while I post this message.  It has been some time since I used it.

If my memory serves me right,  it was designed to help small, outlying
hospital
prepare an infant for transport to a tertiary hospital, if they were unable
to care for it.
I have worked is some VERY small community hospitals that barely qualified
in having
a nursery, let alone, a NICU and could not care for these infants.  The one
I worked in
was approx. 40 miles to the nearest Medical Center, country roads and rural

S.T.A.B.L. E.  stands for :
Sugar
Temperature
Airway
Blood Pressure
Labs
Emotional Support.

Their notation at the end of the class was " this is our opportunity to
teach the outlying
hospitals what to do, what is needed in the way of equipment and supplies,
and
how to transfer the patient more readily".

In my copy:

Page 9 does state " the level of 50 mg/dl or higher for infants being
transported."
    Also at the bottom of the page is states " Remember that the bedside
whole blood
glucose monitoring systems can reflect a 10-15 % lower value than the
plasma,
therefore this method of screening provides only an estimation of the actual
plasma blood sugar.

Now remember this program was written in 1984 originally and copywriting in:
1993,1995,1996.
I don't know if it has been altered since then.

Our method of measuring blood glucose has come a long way and is much more
accurate than then.
She mentions on this page also the types of testing methods used then:
Chemstrips, One-touch, and Dextrostixs.
Think about how more accurate our instruments are now.  The hospital
Neonatologist,  where I took this
 program changed the set limits.  For the Newborn nursery > 40 was accepted
and for the NICU > 45
was accepted.  Think you could get your hospital / doctors to modify the
standards????

But on page 11 a notation is made "The following information covering blood
sugar greater than
40 and less than 50 - treatment options, pertains to the infant being
transported and does not
 necessarily apply to the Newborn presenting only with hypoglycemia.  I have
heard of some hospitals who accept
a level of 35 if not severely symptomatic, in the NBN.

Think too about all that can be wrong with a transported infant:
Respiratory distress, Cold stress,
Anomalies, and the list goes on.  All of these expend energy, and thus the
potential for lowering the
infant glucose even more and causing more problems.

As I remember then and in the NICU that I work in now - the infant is placed
NPO, and has an IV
of D10W (glucose & water).

Now as an RN who is also IBCLC (though not working in that capacity at this
time) I can see both sides.
I am not familiar with your hospital, or the supporting Level III nursery in
your area, but my first though is:
I wonder if your hospital is just looking for a set of guidelines to help
them help your babies and not looking
to shoot down the breast feeding efforts.   I know what it is like to be
left out of the loop, when looking
at new information or policies

Do you think there might be some room for compromise - Depending on the
situations ???

Just a thought or two.
Ann Slaughter RN, IBCLC


> Date:    Fri, 7 Jan 2005 19:55:35 EST
> From:    Kathy Bowers <[log in to unmask]>
> Subject: S.T.A.B.L.E. HYPOGLYCEMIA GUIDELINES
>
> 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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