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Hypoglycemia Protocol Revision

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by

Richard Brucker

on 8 November 2017

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Transcript of Hypoglycemia Protocol Revision

Hypoglycemia Protocol Revision
American Academy of Pediatrics Recommendations
TWO PROTOCOLS - ASYMPTOMATIC
REMINDER ABOUT MOTHER-BABY-UNIT
Current Protocol
Asymptomatic and low glucose?
Conclusion
Feed and recheck glucose in 1 hour
Repeat glucose low?
YES: Confirm with iSTAT, notify MD, feed (may gavage),IV dextrose push, start D10drip and transfer to NICU
NO: Is repeat glucose
>=40 mg/dL at 0-4 hours of life OR
>=45 mg/dL at >=4 hours of life.
YES: Resume routine preprandial screening
NO: Feed, notify MD (gavage feed and/or D10 push may be considered) and recheck in 1 hour
LOW:
<25 at 0-4 hrs
<35 at 4-24 hrs
<45 at >24 hrs
POSITIVES:
Currently follows AAP algorithm

NEGATIVES:
Not actually followed.
Often nurses do not call MD if repeat glucose is not considered "low" but is not yet above target (40 at 0-4 HOL or 45 at >4 HOL).
This protocol allows babies to hover in the low range without sending them to the NICU
This provides a strain on the nursing resources in the mother baby unit, a unit not intended to take care of sick babies.
Why change the algorithm ?
Get rid of meconium as an indication.
Adjust the timing of the initial screening.
With such high turnover of the nursery residents and variety in care practices of primary care providers, come up with a safe protocol that catches babies who are teetering just above the low range, but technically is still below the "target glucose" as defined by the AAP.
NICU PREFERENCE
MBU PREFERENCE
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