The nurse is caring for a 6-hour-old, full-term newborn of a mother with gestational diabetes. A bedside capillary blood glucose measurement reveals that the newborn's blood glucose level is 45 mg/dL (2.5 mmol/L). The newborn is asymptomatic. What is the nurse's first action?

Question

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Poorly controlled diabetes mellitus during pregnancy exposes the fetus to high blood glucose (BG) levels. This results in fetal hyperglycemia, which causes insulin hypersecretion by the fetus and promotes abnormal growth and storage of fat (macrosomia). Immediately after birth, transient hyperinsulinemia and sudden cessation of the maternal glucose supply put the newborn at risk for hypoglycemia. Although there is no standard definition for newborn hypoglycemia, a normal range for serum BG in a newborn age <24 hours is 40-60 mg/dL (2.2-3.3 mmol/L), and a low BG is <40-45 mg/dL (<2.2-2.5 mmol/L). If a newborn has a low BG and is asymptomatic, immediate feeding with formula or breast milk should begin to increase BG and prevent further hypoglycemia (Option A). (Option B) If the newborn is symptomatic or BG levels remain <40-45 mg/dL (2.2-2.5 mmol/L) after feeding, the nurse should notify the health care provider and prepare to administer IV glucose. (Option C) Although cold stress may cause hypoglycemia, feeding and keeping the newborn warm via skin-to-skin contact are priorities. (Option D) Newborns who have hypoglycemia and are symptomatic (eg, poor feeding, jitteriness, irritability) or those whose BG is not increased through feeding require IV glucose administration. Educational objective: Hypoglycemia occurs commonly in newborns of mothers with diabetes due to elevated insulin levels and consumption of stored glucose. Common signs include poor feeding, jitteriness, and irritability. Asymptomatic newborns with low blood glucose (<40-45 mg/dL [2.2-2.5 mmol/L]) should be fed breast milk or formula immediately.

The Nurse Is Caring for a 6-Hour-Old, Full-Term Newborn of a Mother