Purpose for the Program
Newborn hypoglycemia in the delivery room is a widespread challenge. Most often infants who are breastfed and are temporarily separated from their mothers receive formula as a quick fix to increase blood glucose levels. This approach not only decreases breastfeeding success, but it also exposes the newborn to unstable levels of glucose because of the formula's stimulation of insulin production. Too many infants who are breastfed receive excessive amounts of formula within the first hour of life because their glucose values are checked before feeding, as soon as 15 to 30 minutes after birth. After witnessing a 40-minute-old newborn receive 40 ml of formula for a glucose level of 40, then promptly vomit, gag, and turn dusky, I decided it was time to act on my concerns that something was out of balance regarding the blood sugar/feeding issue.
To attain stable glucose levels in babies who are breastfed by giving infants drops of colostrum, feeding them before labs are checked, and keeping them in continuous skin-to-skin contact. I had recently become an international board certified lactation consultant, and that new level of knowledge, coupled with my nursing experience, prepared me well for presenting my ideas to the administration. I also proposed that we establish ways to give colostrum to babies who were not ready to latch effectively. I wanted to rewrite the existing breastfeeding policy, have nurses adhere more vigilantly to our skin-to-skin policy, write a policy on prebirth hand expression of colostrum, and be a driving force to change many of the parameters of the newborn hypoglycemia algorithm.
Implementation, Outcomes, and Evaluation
We have successfully implemented a new hypoglycemia algorithm that accepts lower glucose values initially, has the newborn feed first, and then the first glucose level checked by 90 minutes of age. We have implemented widespread hand expression of colostrum, before and after childbirth, for all of our diabetic patients who are breastfeeding, and we have maintained continuous skin-to-skin contact as a norm. The outcomes to date have been a decrease in separation of the mother and baby, higher newborn glucose levels, higher patient satisfaction, and better success of breastfeeding.
Implications for Nursing Practice
Labor and delivery nurses are the first line of defense in helping stabilize newborn glucose levels without the introduction of formula, thereby upholding the standard of best practice. It is possible for just one nurse with a vision to apply evidence-based practice to achieve quality outcomes.