This 2023 care process model explains current practices for screening, testing, and treating hypoglycemia in newborns with gestational ages ≥35 0/7 in the University of Utah Hospital’s Well Baby and Intermediate Care Nurseries in the first 48 hours of life. Brief management recommendations for persistent hypoglycemia after 72 hours are also included.

• Hypoglycemia is defined as a glucose < 45 mg/dL during the first 48 hours of age.
• Initiate breastfeeding within the first hour after delivery whenever possible. Use recommended volumes for formula or donor milk if breastfeeding is not an option.
• Check the first screening glucose for infants with risk factors for hypoglycemia at 2-3 hours of life, including:
  • Prematurity (<37 weeks)
  • Small for Gestational Age (SGA) (weight <10%ile)
  • Infant of a diabetic mother (IDM)
  • Large for Gestational Age (LGA) (weight >90%ile)
  • 10-minute APGAR <7
  • Polycythemia (Hematocrit >65%)
  • Maternal terbutaline, beta-blockers, or antenatal steroids within 48 hours prior to delivery
  • Microphallus (<2cm) or midline defects
• Check glucose immediately if there are signs or symptoms of hypoglycemia, including:
  • Seizures, coma, hypotonia, or lethargy
  • Jitteriness, irritability
  • Apnea, cyanosis, tachypnea
  • Persistent oxygen need beyond transition period
  • Hypothermia or fever
  • Poor suck or refusal to feed
  • Persistent tachycardia or bradycardia
• Treat low point of care (POC) glucoses while awaiting results with oral dextrose gel or intravenous (IV) dextrose, following the algorithm. POC glucoses <40 mg/dL will be sent automatically to the lab for confirmatory testing (this is a lab process based on error range of POC glucose). Don’t send confirmatory testing on POC glucoses >40 mg/dL.
• Use clinical judgment and nursing communication orders on how to wean dextrose infusion for glucoses >50mg/dL.

Wight NE.
ABM Clinical Protocol #1: Guidelines for Glucose Monitoring and Treatment of Hypoglycemia in Term and Late Preterm Neonates, Revised 2021.
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Adamkin DH.
Postnatal glucose homeostasis in late-preterm and term infants.
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