Inpatient Clinical Pathway for Glucose Monitoring
of the Healthy Newborn, 0-48 Hours of Age

Assess for Symptoms and Risk Factors for Hypoglycemia
Asymptomatic
WITHOUT Risk Factors
Asymptomatic
WITH Risk Factors
No further action
Feed within 1 hr of life
BG > 40 mg/dL
BG ≤ 40 mg/dL
  • Consider Neonatology consult
  • Identify other etiologies that
    cause symptoms
  • If risk factors present, check
    until 2-3 consecutive BG
    • > 40 mg/dL for < 24 hrs of age
    • > 50 mg/dL for 24-48 hrs of age
Check Blood Glucose (BG)
30 minutes after feed
BG > 40 mg/dL
BG 25-40 mg/dL
BG < 25 mg/dL
Check BG pre-feed (Q2-3 hr)
  • Apply gel and refeed
  • Breastfeed w/good latch
  • Give pumped/donor breastmilk if available
  • Consider formula supplementation
  • Suggested Feeding Volumes
  • Consult Neonatology
  • Apply gel and refeed
    • Consider pumped/donor breastmilk, formula
      as indicated
  • Consider IV Dextrose Treatment
Recheck within 1 hr of feed
Continue BG checks every 2-3 hrs pre-feed
BG > 40 mg/dL
BG 25-40 mg/dL
BG < 25 mg/dL
    • Apply gel up to 3 doses
    • Refeed, must give pumped breastmilk if available
    • And/or
    • Supplement with donor breastmilk or term formula
    • Consider 22 calorie formula
Check 2-3 more consecutive blood glucose
Goal BG
> 40 mg/dL for < 24 hrs of age
or
> 50 mg/dL for 24-48 hrs of age
BG 25-40 mg/dL
If BG < 25 mg/dL consult Neonatology
Recheck BG within 1 hr
Continue BG checks
every 2-3 hrs pre-feed
BG < 40 mg/dL ≥ 3 times
    • Consult Neonatology
    • Consider IV Dextrose Treatment
    • Consider 4th dose glucose gel
      to support infant during transfer to N/IICU
Posted: May 2014
Revised: December 2023
Editors: Clinical Pathways Team