Dear Nancy and other pediatric clinicians,
This is a follow up question to management of hypoglycemia in the full term  
newborn.  
Nancy, thank you for clarifying that the amount for supplements is 3-10  
ml/kg at the ABM site, is that true at the AAP site?  
But what if a baby takes less than that of colostrum?  The scenario is  a 
baby having at least some reason to be admitted to a Level II nursery so blood  
sugars are now being monitored.  This baby is not interested in feeding so  
either is licking colostrum or mom has expressed a small amount (less than 3 cc  
per kg) and this is feed to the baby.  
As the clinician managing this baby would you insist that the baby be  
supplemented with formula to make the required amount per kg or would you check  to 
see if the colostrum was enough to stabilize the blood sugar?  
I ask this because this is what I observe more often than not.  These  babies 
usually are not that interested in nursing or feeding and have an IV  
running.  Mom's will use skin to skin and hand express their colostrum but  the 
intake appears to be very little.  The first comments made is that the  baby has to 
have a certain amount in so the IV can be cut back and  discontinued.  If the 
staff does not feel this amount is made they  supplement.  I have offered to 
just check the blood glucose and they  sometimes will do this but most of the 
time they insist on a certain amount that  has to be given to a baby.
With the literature supporting that skin to skin can increase blood sugars  
and then add the high protein colostrum, are these not enough to prevent  
hypoglycemia in a baby?
Thanks to any and all responses.
Ann Perry, RN IBCLC
Boston, MA



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