Glucose Monitoring of the Healthy Newborn, 0 to 36 hours of age
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Asymptomatic
WITHOUT Risk Factors
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Asymptomatic
WITH Risk Factors
Symptomatic
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No further actions needed
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Initiate Feeds within
1 Hour of Life
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Check Glucose at
2 Hours of Life
Check glucose at 1 hour of life if:
  • Infant of diabetic mother
    Severe SGA
    Infant unable to feed
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Glucose 30-45
Glucose 20-30
Glucose < 20
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Look for another
etiology for infant's
symptoms and continue to check
AC glucose until 2 more are ≥ to 50
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Check Blood Glucose
Immediately
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Glucose ≥ 45
Glucose < 45
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Glucose ≥ 45
  • Continue feeding every 2-3 hours
  • Repeat AC in 2-3 hours, before feed
  • Follow algorithm below based on glucose results
  • Continue to follow instructions based on result until there are 2 results, 6 hours apart, greater than or equal to 50
  • Notify practitioner if concern for any symptoms
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Feed by mouth or gavage:
  • Breastfeed, expressed breast milk
    (any amount)
  • Formula, 5-10 mL/kg
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Recheck Glucose
30 minutes after feed completed
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Glucose ≥ 45
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Glucose < 45
Notify Practitioner while
proceeding:
  • Retest glucose at bedside
    • I-STAT or Accucheck
  • Send STAT lab glucose, but do not wait for result to proceed with pathway
  • If clinically stable feed expressed breast milk (any amount) or formula, 5-10 mL/kg
  • Practitioner may opt for NG feed
  • Recheck 1/2 hour after feeding ended – or 1 hour after last check
Notify Practitioner and transfer infant to NICU for IV treatment
  • If stable, infant may be fed while preparing for IV fluids, but there should be no delay in IV treatment
  • Infants with glucose < 20 will not correct with feeding alone.
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Glucose < 45
Glucose ≥ 45
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Age >4 hours
Glucose Actions
< 30 Notify practitioner, IV Treatment Pathway
30-39

Notify practitioner

Feed Breastfeed or expressed breast milk or formula PO, gavage
Repeat AC 30 minutes after feeding finished
If < 45 Notify practitioner, admit NICU / SCN
If ≥ 45 Repeat AC in 2-3 hours
40-49 Repeat AC in 2-3 hours
≥ 50 Repeat AC in 6 hours, if ≥50 may stop glucose monitoring
Note: Late preterm and SGA should have follow-up AC chem at 24-36 hours
Infants > 24 hours old with glucose persistently 30-44 evaluate and treat with IV fluids
Posted: May 2014
Revised: April 2017
Authors: C. Hufnal, MD; J. Chuo, MD