The nurse is caring for an exclusively breastfed, small-for-gestational age, term newborn at 6 hours of life. The newborn has a capillary blood glucose (BG) of 30 mg/dL (1.67 mmol/L) and is asymptomatic. Which action is most appropriate for the nurse to take at this time?

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Newborns at increased risk for hypoglycemia after birth include those who are large or small for gestational age, whose mothers have diabetes, or who were born at the late preterm age. Asymptomatic hypoglycemia in newborns with blood glucose (BG) <35 mg/dL (<1.94 mmol/L) if age 4-24 hours or <25 mg/dL (<1.39 mmol/L) if age <4 hours should be initially treated with feeding; an exclusively breastfed newborn should receive breast milk when possible (Option B). Feeding the newborn is a simple, noninvasive method of increasing and stabilizing BG. (Option A) IV glucose is not first-line treatment for asymptomatic hypoglycemia. IV glucose is indicated for newborns who do not tolerate oral feedings, who are symptomatic (ie, lethargic, jittery), or whose BG does not increase with feeding. (Option C) The priority is to stabilize BG, which can be done by initiating the mother's desired feeding method. Obtaining a prescription for formula supplementation (ie, via cup or spoon) may be necessary if breastfeeding is not adequate. (Option D) An ideal BG for the newborn is ≥40-45 mg/dL (2.2-2.5 mmol/L). BG <40-45 mg/dL should be confirmed with a plasma blood sample. Nevertheless, feeding the newborn may be initiated without waiting for a plasma BG level. Educational objective: Asymptomatic hypoglycemia in newborns with blood glucose <35 mg/dL (<1.94 mmol/L) if age 4-24 hours or <25 mg/dL (<1.39 mmol/L) if age <4 hours should be initially treated with feeding. Feeding is a simple, noninvasive method of increasing and stabilizing blood glucose.

The Nurse Is Caring for an Exclusively Breastfed, Small-For-Gestational Age