Newborn hypoglycemia in the Delivery Room is a widespread challenge, and most often breastfed babies are separated from their mothers and receive formula as a "quick fix" to increase blood glucose levels. This approach not only decreases breastfeeding success, but it also sets the newborn up for more unstable glucoses due to formula's stimulation of insulin production. Too many breastfeeding babies were receiving way too much formula within the first hour of life, having glucose values checked as soon as 15 -30 minutes after birth. When a 40 minute old "breastfeeding" newborn received 40 ml of formula for a glucose of 40, then promptly vomited, gaged and turned dusky, I decided it was time to act on my concerns that something was totally out of balance regarding this whole blood sugar/feeding issue. 

Proposed change:

I proposed that we could attain stable glucose levels in breastfeeding babies with just drops of colostrum, feeding them FIRST before labs were checked, and keeping them in continuous skin to skin contact. I had recently become an IBCLC, and that new level of knowledge, coupled with my 30 plus years of high risk labor & delivery nursing prepared me well for presenting my ideas to administration. I also proposed we establish ways to get the colostrum to the babies that weren't ready to latch effectively.  I wanted to rewrite the exisiting Breastfeeding Policy, have nurses adhere more vigilantly to our Skin to Skin Policy, write a Pre-Birth Hand Expression of Colostrum Policy, and be a driving force to change many of the parameters of the Newborn Hypoglycemia Algorithm.

Implementation, outcomes and evaluation:

We have successfully implemented a new Hypoglycemia Algorithm that accepts lower glucose values initially, has the newborn FEED FIRST, then the first glucose checked by 90 minutes of age.  We have implemented widespread hand expression of colostrum for all of our breastfeeding diabetics both PRE and POST birth, and we have maintained continuous skin to skin contact as a norm. The outcomes to date have been less separation of mother and baby, higher newborn glucose levels, higher patient satisfaction, and better breastfeeding success. 

Implications for nursing practice: Labor & Delivery nurses are the FIRST LINE of DEFENSE in helping newborns stabilize their glucose levels without the introduction of formula, thereby upholding the standard of "BEST PRACTICE".  It is possible for just one nurse with a vision to "apply evidence-based practice to achieve quality outcomes."  

Keywords:

Hypoglycemia

Diabetics

Hand Expression

Colostrum

Skin to Skin