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Subject:
From:
"Becky Engel, RN, IBCLC" <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Fri, 28 Jun 1996 23:57:47 -0400
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IMHO, glucose screens for asymptomatic babies tend to be torture for the
babies, families, and nursing staff.

Our hospital's protocol for treating hypoglycemia in the neonate is sort of
"breastfeeding neutral". The protocol requires screening for a variety of
reasons. (We do a LOT of glucose screens.) The protocol states that a lab
confirmation must be done for results less that 40. The lab may take up to 30
minutes to come draw a STAT blood glucose. We nurses feed (or have the mother
breastfeed) the asymptomatic baby ASAP (As Soon As Possible). Of course, this
means that we are not getting a confirmation of the glucose screen we just
did, since the baby has eaten. Very few confirmations indicate
"hypoglycemia".

If the confirmation is OK, we just keep observing and feeding and notify the
doctor on rounds. If not, we immediately call the pediatrician. The doctors
vary in their recommendations. Most recommend formula as a supplement. A few
prefere 5% glucose water. Some say to just keep breastfeeding the
asymptomatic baby with a glucose screen between 30 and 40.

When our protocol changed from performing the glucose screens before feedings
to doing the screens at certain time intervals, the incidence of
"hypoglycemia" declined.

The neonatologist wants all breastfeeding babies supplemented, but he is not
every baby's pediatrician. One family did not want supplements, so the
neonatologist ordered glucose screens to be done and the baby supplemented if
below 50. The two results I obtained that afternoon were 53 and 56 (3 hour
intervals).

If the person who wrote the protocol to supplement with formula still has
power, will research findings change anything? Our hospital's changes came
about when "clinical pathways" were being developed and one person did not
"run the show".

Becky Engel, RN, IBCLC
Athens, GA

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