A continuous supply of glucose is provided from the mother to the fetus during pregnancy. Glucose is crucial to brain function, immediately required and rapidly consumed following birth when the glucose supply is abruptly terminated. The healthy neonate is expected to achieve glucose stability soon after birth. Hypoglycemia, defined as plasma value less than 55mg/dL, is a condition which demands attention and treatment because glucose is essential for optimal brain and tissue function. Infants may develop hypoglycemia due to 1) too much insulin, 2) too few reserves and 3) too much demand for glucose. Therefore, the following infants are determined to be at risk for developing hypoglycemia: Infant of a Diabetic Mother (IDM), Large for Gestational Age (LGA), Small for Gestational Age (SGA) and preterm. Also infants encountering stress indicated by an APGAR score less than 6 at one and/or five minutes are at risk for hypoglycemia.

A protocol, developed by the author, and based on clinical evidence, directs the health care provider and mother to identify the timing for measurement of blood glucose and feeding schedule for the infant. Best practice components include: 1) promotion of skin to skin following birth; 2) assisting in breastfeeding or bottle-feeding (mother’s choice) within one hour after birth; 3) standardize appropriate timing for measurement of glucose values; 4) achieve consensus among providers for blood value definition of hypoglycemia and 5) neonatal calibration and consistent use of a glucometer to measure blood value. The risk factor categories are listed separately on the protocol with specific times for glucose measurement and feeding interval based on the risk factor present. If the infants’ blood glucose falls below 55mg/dL, the intervention pathway is then put into place which outlines feeding and follow-up glucose measurements.

Following implementation of the protocol, the incidence of neonatal hypoglycemia decreased from 12% to 2% over one year. The birth volume at Northwestern Memorial Hospital is over 10,000 births/year and reduction of hypoglycemia had a significant impact on the NICU census. Early identification of the infant at-risk and maintaining euglycemia minimized separation of the mother and newborn while earlier breastfeeding led to continued breastfeeding success. This protocol is evidenced based, completely nursing driven and has improved the transition and outcome of newborns at risk for hypoglycemia.