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Screening For Hypoglycemia In Healthy Term Neonates: Effects On Breastfeeding

Authors

  • Nancy C. Haninger CNM, MSM,

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    • Nancy Haninger received her Diploma in Nursing from the Mt. Carmel Hospital School of Nursing in 1971, her Bachelor's of Science in Nursing from Otterbein College in 1997, her certificate in nurse-midwifery from the Institute of Midwifery and Women's Health in 2000, and her Master's of Science in Midwifery from the Philadelphia University in 2000. She has 25 years of clinical experience in perinatal nursing. She has accepted an international midwifery position in Tshikaji, Democratic Republic of the Congo with the Presbyterian Church (USA) and IMCK (Institut Medical Chretien du Kasai).

  • Cynthia L. Farley CNM, PhD

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    • Cynthia Farley received her Bachelor's of Science in Nursing from Ohio State University in 1978, her Master's in Nursing in the nurse-midwifery program from Emory University in 1981, and her Doctor of Philosophy from the Ohio State University in 1999. She has been active in clinical practice for 19 years, most recently negotiating to open a midwifery practice at Greene Memorial Hospital in Xenia, Ohio. She has been involved in midwifery education for 10 years, teaching the antepartum course in CNEP for 8 years and now teaching the critical inquiry course series and an introduction to teaching methods in the Graduate Midwifery Program of the Philadelphia University. She is also Committee Chair of The Ohio Nurse-Midwives Peer Review Committee: A cooperative venture of all Ohio Chapters of the American College of Nurse-Midwives.


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ABSTRACT

Transient hypoglycemia in the early neonatal period is a common adaptive phenomenon as the newborn changes from the fetal state of continuous transplacental glucose consumption to intermittent nutrient supply following cessation of maternal nutrition at birth. Research has demonstrated that in the term, healthy newborn, this dynamic process is self-limiting and is not considered pathologic.

The American Academy of Pediatrics and the World Health Organization recommend that neonatal blood glucose screening be reserved for newborns who are at risk or symptomatic and conclude that universal hypoglycemia screening is inappropriate, unnecessary, and potentially harmful. Nevertheless, many hospital nurseries continue the clinical practice of routine early glucose screening on healthy, term newborns. This results in the misidentification of neonates captured while experiencing the normal, self-correcting physiologic blood glucose nadir who are then diagnosed with pathologic neonatal hypoglycemia.

Subsequent to this misdiagnosis, further surveillance and unnecessary, aggressive treatment interventions will follow that are potentially harmful to the successful establishment of positive maternal-infant interactions and the breastfeeding experience.

Research studies indicate that routine hypoglycemia screens, treatments, and interventions in the healthy infant are not evidence-based and result in a serious disruption of the initiation process and duration patterns of lactation.

Using the perspective of the theory of technology dependency, this inquiry explores the potential adverse sequelae of inappropriate glucose screening in the healthy breastfeeding newborn and describes selected outcome variables including: 1) the consequences of early maternal-infant separation, 2) the influence of early formula supplementation on breastfeeding discontinuance rates, 3) the effect of separation and supplementation on the onset of lactogenesis, and 4) the impact of hospital staff and provider recommendations of formula supplementation on maternal confidence to independently nurture her baby.

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