This was posted on March 1 on Medscape.  If the link does not work, please contact me off list.  It's a lengthy article


http://www.medscape.com/viewarticle/738204

Nothing about skin to skin mentioned :-(

Here's one clip:

According to the guidelines, the infants at highest risk for clinically significant NH are small for gestational age, large for gestational age, born to mothers who have diabetes, or late-preterm. Routine screening and monitoring of blood glucose is recommended only for infants who have these risk factors or who have clinical manifestations of NH such as jitteriness, cyanosis, seizures, an apneic episode, tachypnea, weak or high-pitched cry, floppiness, or lethargy, poor feeding, or eye-rolling.

The guidelines call for immediate intravenous glucose for infants who are symptomatic and have glucose levels lower than 40 mg/dL.

For asymptomatic at-risk infants, the initial feed should be within 1 hour of birth, with glucose screening 30 minutes after the first feed. Because there is no point-of-care screening method reliable enough to be used as the sole method for screening for NH, the blood or plasma glucose concentration must be confirmed by laboratory testing ordered stat.

If NH is suspected, the plasma or blood glucose level should be determined by a laboratory enzymatic method such as glucose oxidase, hexokinase, or dehydrogenase.

Dr. Adamkin and colleagues wrote, "A long delay in processing the specimen can result in a falsely low concentration as erythrocytes in the sample metabolize the glucose in the plasma. This problem can be avoided by transporting the blood in tubes that contain a glycolytic inhibitor such as fluoride."

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