DOCTOR’S ORDER SHEET

DRUG ALLERGIES:

PATIENT IDENTIFICATION ROOM NO.

NEWBORN NEONATAL HYPOGLYCEMIA ORDERS –

CLINICAL PATHWAY

ORDERS FOR MEDICATION, DIET AND TREATMENTS
NEONATAL HYPOGLYCEMIA—(ALL NEWBORNS):
If infant symptomatic (cyanotic, diaphoretic, lethargic, seizure, jittery):
1. Perform AccuChek immediately. If less than 45 mg/dl, obtain serum glucose by Respiratory Therapy.
2. If serum glucose less than 40 mg/dl and infant is in
·  Transition Nursery or Mother/Baby setting:
a. Move infant to radiant warmer.
b. Administer mini-bolus of D10W at a rate of 2 ml/kg IV Push over 2 minutes.
c. Begin IV maintenance fluids of D10W at 4 ml/kg/hr.
d. Repeat AccuChek 15 minutes after mini-bolus.
e. Initiate Neonatology consult (ext. 4902) for admission to NICUand notify pediatrician.
f. If unable to obtain IV access within 10 minutes, notify Neonatology (ext. 4902) and NICU
charge nurse (ext. 4923) for IV access prior to transport to NICU.
·  Labor & Delivery setting:
Notify Neonatologist (ext 4902) for NICU admission
*ROUTINE GLUCOSE SCREENING—(LGA, SGA, IDM, and / or LATE PRETERM INFANTS (35 – 36 6/7 weeks):
INITIAL Routine Glucose Screening for LGA, SGA, IDM, and / or Late Preterm Infant at 0 – 4 hours of age
1. Feed within the first hour of life – (breast or nipple/gavage pediatrician’s formula of choice - 30 ml)
2. Perform AccuChek 30 minutes after feed
a. If AccuChek is less than 25 mg/dl and infant is stable, repeat feed (breast or nipple/gavage
pediatrician’s formula of choice - 30 ml) immediately and repeat AccuChek 1 hour after 2nd feed.
b. If AccuChek after 2nd feed is less than 45 mg/dl, have Respiratory Therapy perform serum glucose.
·  If serum glucose less than 25 mg/dl, begin orders as noted above in # 2 for
“NEONATAL HYPOGLYCEMIA.”
·  If serum glucose 25 – 40 mg/dl, consult neonatology (ext. 4902) for further orders.
SUBSEQUENT Routine Glucose Screening for LGA, SGA, IDM, and / or Late Preterm Infant
LGA or IDM: Feed at least every 2 – 3 hours or on-demand and perform AC AccuChek for 1st 12 hours of life. (Do not delay feedings).
·  If results greater than or equal to 35 mg/dl, continue AC AccuCheks as ordered.
·  If AccuChek less than 35 mg/dl, feed immediately and repeat AccuChek 1 hour after feed and then if AccuChek is less than 35 mg/dl, consult Neonatology (ext. 4902) for further orders.
·  If results are 35-45 mg/dl, contact pediatrician for supplementation/refeeding orders or neonatology consult
·  Discontinue AC AccuCheks after 12 hours of life if last two consecutive screening results are greater than or equal to 45 mg/dl.
·  If last two consecutive screening results are less than 45 mg/dl, contact Pediatrician for further orders.
SGA or Late Preterm (35 – 36 6/7 weeks gestation), feed at least every 2 – 3 hours or on-demand and perform AC AccuChek for 1st 24 hours of life. (Do not delay feedings).
·  If results greater than or equal to 35 mg/dl, continue AC AccuCheks as ordered.
·  If AccuChek less than 35 mg/dl, feed immediately and repeat AccuChek 1 hour after feed and then if AccuChek less than35mg/dl, consult Neonatology (ext. 4902) for further orders.
·  If results are 35-45 mg/dl, contact pediatrician for supplementation/refeeding orders or neonatology consult
·  Discontinue AC AccuCheks after 24 hours of life if last two consecutive screening results are greater than or equal to 45 mg/dl.
·  If last two consecutive screening results are less than 45 mg/dl, contact Pediatrician for further orders.
* Routine AccuCheks are required for LGA, SGA, IDM INFANTS, and late preterm infants (35 - 36 6/7 weeks gestation) only

4/2013 NEWBORN NEONATAL HYPOGLYCEMIA ORDERS – CLINICAL PATHWAY