Neonatal Hypoglycemia Protocol Quiz

Neonatal Hypoglycemia Protocol

• 0-4 Hours of Life:
  • Initial feed within 1 hour of birth.
  • Glucose screen 30 minutes after first feed or within 2 hours of life (whichever is earlier).
  • If glucose <30 mg/dL: administer glucose gel, skin-to-skin contact, and feed (breast/bottle).
  • If glucose ≥30 mg/dL: Continue breastfeeding every 2-3 hours or on demand. Rescreen glucose 1 hour after feed. Repeat if <30 mg/dL.
• 4-24 Hours of Life:
  • Glucose screen every 3 hours.
  • Assess glucose prior to feed (breast/bottle).
  • If glucose<40 mg/dL: administer glucose gel, skin-to-skin contact, and feed (breast/bottle).
  • Rescreen glucose 1 hour after feeding.
  • If <35 mg/dL: notify physician and consider transfer to NICU.
  • If glucose >40 mg/dL: Continue breastfeeding every 2-3 hours or on demand. Maintain glucose screening until 3 consecutive results are >45 mg/dL. Then rescreen at 36 hours of life, prior to feed, if glucose gel was given during the infant's stay.
• **Important Considerations:**Maximum 3 consecutive doses of glucose gel and/or a maximum of 6 doses in 48 hours. Alert physician for further evaluation of persistent hypoglycemia If the 3rd consecutive dose or 6th dose in 48 hours is given.

Modified Sarnat Neurological Examination

• Purpose: Assess severity of neonatal encephalopathy, helpful in determining if therapeutic hypothermia or normothermia is necessary.
• Timing: Performed at initial assessment, during hypothermia treatment, and after 72 hours of cooling.
• Key Areas:
  • Level of consciousness
  • Spontaneous activity
  • Posture
  • Tone (hypotonia, hypertonia)
  • Primitive reflexes (e.g., suck, Moro)
  • Autonomic nervous system (e.g., pupils, heart rate, respiration)
• Examination Techniques:
  • Infant positioned supine with head midline.
  • Minimal handling initially, assessing posture/activity/autonomic system first.
  • Evaluate response to stimuli, including touch, light and sound.
  • Evaluate head circumference/shape and other birth-related injuries for any abnormalities.
  • Observe any general body muscle mass (such as small for gestational age), and joint contractures.
  • Record maternal medication history.
• Grading:
  • Observe baby for at least one minute without disturbing, noting Heart Rate (HR), Respiration Rate (RR) and Temperature.
  • Assess using normal, mild, moderate and severe scores for each category.
• Severity Classification: Based on presence of 3 categories scoring either moderate or severe, or presence of clinical seizures.

This quiz covers the neonatal hypoglycemia protocol focusing on the initial 0-24 hours of life. It discusses glucose screening, administration of glucose gel, breastfeeding recommendations, and when to notify a physician. Test your knowledge on best practices for managing newborns at risk of hypoglycemia.