THE POSTNATAL WARD
Risk factors for hypoglycaemia
The British Association of Perinatal Medicine has a breastfeeding friendly guideline on hypoglycaemia in the first 48 hours of life. Babies with risk factors for hypoglycaemia should receive proactive breastfeeding support, which can start antenatally if the risk factors are known in advance. BAPM recommends that only babies of mothers with gestational diabetes, use of beta blockers in the third trimester, birthweight <2nd centile and late preterm babies be considered as routinely at risk on the postnatal ward. Large babies would only be considered at risk if they had specific features making a health professional suspicious of macrosomic disorders such as Beckwith-Weidemann.
Babies with risk factors should be encouraged to breastfeed within the first hour, experience immediate and prolonged skin to skin contact, and mothers should be given intensive support to recognise feeding cues, breastfeed and express colostrum if there are any concerns about feeding efficacy. There should be a maximum feed interval of 3 hours - this does not mean feeding 3 hourly, if a baby wants to feed more often this is welcomed.
Action should only be taken for blood glucose levels that have been checked on a ward-based blood gas analyser (or new highly accurate bedside machines) - as standard bedside glucometers only provide accuracy with a range of 0.8mmol/l.
First action for hypoglycaemia should be to feed the baby - if the baby doesn't breastfeed this can be replaced by giving as much colostrum as the mother can express - BAPM confirmed in the consultation stage of their guidance that no specific volume target is required at the first occurrence of hypoglycaemia. Second line action is to give dextrose gel alongside a feed. If hypoglycaemia recurs again a specific volume feeding plan may be required. Admission to the neonatal unit may be required for hypoglycaemia screen (with suspicion of hyperinsulinism) or assessment of other contributing cause. Post-feed blood glucose measurements are not recommended unless the baby is on intravenous dextrose.
For a quick summary of the BAPM hypoglycaemia framework for practice, covering dextrose gel and colostrum volumes, see this Archives Guideline Summary (paywall).