SDMS ID: P2010/0392-001 14.

16-07WACS Title: Replaces: Description: Target Audience: Key Words: Policy Supported: Hypoglycaemia in Healthy Term Newborns Hypoglycaemia in the Newborn Policy 4.6 Management of hypoglycaemia in healthy term newborns Midwives and medical officers, QVMU Hypoglycaemia in health term newborns P2010/0384-001 Postnatal Ward Management of Term Newborns at Risk of Hypoglycaemia P2010/0299-003 Breastfeeding Protocol Purpose: Healthy full term infants born after a normal pregnancy and delivery and who do not display clinical signs of hypoglycaemia do not require screening or monitoring for hypoglycaemia Definitions: Healthy term infants are those born between 37 to 42 weeks and are an appropriate size for gestation age. There is no universally agreed definition of hypoglycaemia. Procedure: Maintenance of normal body temperature is necessary to prevent hypoglycaemia. If there are any concerns that the term newborn is becoming hypoglycaemic the infant should be given another breastfeed. Healthy term newborns do not develop symptomatic hypoglycaemia as a result of simple underfeeding. If an infant develops signs suggesting hypoglycaemia look for an underlying condition. Detection and treatment of the cause is as important as correction of the blood glucose level. Routine screening/monitoring of blood glucose levels in normal term infants is only warranted if there are obvious clinical signs (symptomatic hypoglycaemia). If any newborn shows clinical signs of hypoglycaemia the blood glucose level should be measured. If the blood glucose level is less than 2.6 mmol/L the paediatric registrar must be informed and clinical interventions aimed at increasing blood glucose level are indicated as per the Clinical Guideline Postnatal Ward Management of Term Newborns at Risk of Hypoglycaemia. Subsequent blood glucose levels are not indicated in jittery babies who have a BSL > 2.6mmol/L and are feeding well.

Hypoglycaemia in Healthy Term Newborn May-11

Signs of Hypoglycaemia The clinical signs of hypoglycaemia are non-specific and associated with other disorders common in the neonate. These include: Abnormal or high pitched cry Hypothermia Poor temperature control Sweating Poor suck Refusal to feed Tremors Exaggerated Moros reflex Irritability Lethargy Hypotonia Seizures Cyanosis Pallor Tachypnoea Apnoea Abnormal eye movement Tachycardia Congestive heart failure Respiratory distress Attachments
Attachment 1 Attachment 2 Attachment 3 References Collection of Blood Sample - Haemacue Breastfeeding Flow Chart for First 24 Hours Healthy Term Newborns

Performance Indicators: Evaluation of compliance with guideline to be achieved through medical record audit annually by clinical Quality improvement Midwife WACS Review Date: Annually verified for currency or as changes occur, and reviewed every 3 years via Policy and Procedure working group coordinated by the Clinical and Quality improvement midwife. November 2009 Midwives and medical staff WACS Dr A Dennis Co-Director (Medical) Sue McBeath Co-Director (Nursing & Midwifery) Womens & Childrens Services Sue McBeath Co-Director (Nursing & Midwifery) Womens & Childrens Services

Stakeholders: Developed by:

Dr A Dennis Co-Director (Medical) Womens & Childrens Services Date: _________________________

Hypoglycaemia in Healthy Term Newborn May-11 2

ATTACHMENT 1 References:
Cornblath M, Hawdon JM, Williams AF, Aynsley-Green A, Ward-Platt MP, Schwartz & Kalhan SC 2000 Controversies regarding definition of neonatal hypoglycaemia: suggested operational thresholds Pediatrics, vol:105, no:5. Despande S & Ward Platt M 2005 The investigation and management of neonatal hypoglycaemia Seminars in Fetal & Neonatal Medicine Vol:10. Hewitt V, Watts R, Robertson J & Haddow G 2005 Nursing and midwifery management of hypoglycaemia in healthy term neonates, International Journal of Evidence Based Healthcare, vol: 3: pp169-205. Moore AM & Perlman M 1999 Symptomatic hypoglycaemia in otherwise healthy, breastfed term newborns Pediatrics 1999, vol:103, no: 4. NETS Victoria Neonatal Handbook 2006 Hypoglycaemia Online: http://www.rwh.org.au/nets/handbook/index.cfm?doc_id=631 Royal Prince Alfred Hospital Department of Neonatal Medicine Protocol Book 1998 Hypoglycaemia Online: http://www.cs.nsw.gov.au/rpa/neonatal/html/newprot/hypogly.htm World Health Organisation 1997 Hypoglycaemia of the newborn review of the literature. Viewed online: http://www.who.int/reproductive-health/docs/hypoglycaemia_newborn.htm

Hypoglycaemia in Healthy Term Newborn May-11

APPENDIX 2

Collection of Blood Samples

Hemocue Glucose and Haemoglobin
Point of care testing equipment provides reliable results PROVIDED the sample is of the highest quality.

Essential Steps in collection of Capillary Glucose/Hb Samples (HemoCue)

1 Ensure a Good Blood-flow A good and rapid blood-flow is the most critical step. Wipe away the first drop The first drop of blood will contain tissue fluids which may distort the final result Allow a large drop to form The drop of blood must be large enough to fill the cuvette in one action. DO NOT milk for sample; this will add tissue fluids which will distort the result. Fill the Cuvette Fill in a single action from a large blood drop. Avoid bubbles. DO NOT top up the cuvette if not completely filled. Discard the cuvette and try again if not completely filled. Wipe the Cuvette Carefully wipe any excess blood from the outside of the cuvette with a tissue. Be careful not to wick any blood out from the inside of the cuvette. Be equally carefully not to smear excess blood over the outside of the cuvette. Analyse Sample Insert sample into analyser as soon as possible after filling (maximum time delay 40 seconds). You CANNOT remeasure a cuvette to check the result.

Hypoglycaemia in Healthy Term Newborn May-11

APPENDIX 3

BREASTFEEDING MANAGEMENT FLOW CHART FOR FIRST 24 HOURS HEALTHY TERM NEWBORNS

Hypoglycaemia in Healthy Term Newborn May-11

WACSClinProc4.16