We have modified our routines over the 12 years I have worked at my
current hospital.  It's still not what I'd like to see, but has
gotten better.  We only test "at risk" babies-defined as outside the
37-41 week gestational age, infant of diabetic mom, LGA or SGA and a
long list of pregnancy or birth complications (not including
C/Sections).  They are tested within the first hour after birth
(with the electronic hand held units) and at 3 hours.  Further
testing is done if the baby's MD orders them.  Originally the
protocol stated any reading under 45 required immediate formula
feed!.  Now it's a little better.  Over 40-no action required unless
symptomatic.  30-40 and asymptomatic, feed (breast or bottle
depending on mom's plans), recheck 30 minutes after feed.  If still
below 40, lab level is done.  If below 30 or 30-40 and jittery, they
are to be fed formula regardless of mom's plans to nurse.
One important thing we have noted is the importance of warming the
infant's foot before obtaining the sample. I have seen 5-10 points
difference with the numbers often falling below protocol if the heel
hasn't been warmed and above the minimums if the heel was warmed
first!
Winnie Mading, RNC, IBCLC

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