Hi Jo, Have you seen the WHO paper "Hypoglycemia of the Newborn" ? (I think that is the name of it and I think can be found on the WHO website). Very helpful for establishing guidelines around blood glucose testing and treatment.
Meaghan Moon Brandon, Manitoba, Canada At 11:54 AM 9/18/02 +1000, you wrote: >I'm sure you guys will be sick of me by now, but bad stuff just keeps >happening when I'm around... > >A large baby was born: 4.590kg. Policy says the baby should have a BSL >done because he was 'at risk' due to his size. > >BSL came back at 1.7mmol. Anything under 2.5 is unacceptable, and must be >follwed by a TBG (True Blood Glucose) which is sent to the pathology lab >for an accurate result. This often requires the baby to be pricked twice, >as the BSL machine is just the same as those adult finger prick ones, and >not enough blood for a TBG can usually be extracted. So if the BSL result >comes back too low, a larger lancet (same as for a NST) is used to get a >small vial of blood. > > Policy also says that you are not to wait for the TBG result before > acting on the BSL result. So, this exclusively breast fed baby was given > formula. Mum was consulted (after I told the midwife from SCN that of > course you have to ask her first!) and reluctantly said, "If he has to > then I guess he has to... but can I still breast feed him?" So the baby > was given formula. (NO idea why not breast... I think because 'he is > such a big boy and colostrum isn't enough for him'.) > >A little while after the formula was given, the result of the TBG came >back as 3.6mmol. I couldn't believe it... this baby was given formula FOR >NOTHING. The BSL is known to be inaccurate, especially when results come >back under 3.0, which is why the TBGs are done. > >What I didn't get is why the TBG isn't done in the first place, skipping >the BSL all together? > >My answer was that the TBG result takes too long to come back from the >lab, and if the sugar is too low and the baby needs feeding now, there >could be a bad outcome (brain damage, etc). I understand this, but this >baby was showing NO sign of hypoglycaemia (and he wasn't hypo... he had a >TBG of 3.6) and he could have quite safely waited for the TBG result... > >So, I put this to the manager of the SCN... She agrees that too many >babies recieve formula unnecessarily, and agrees that a TBG should be the >first line of glucose testing (especially for these once-off 'at risk' >baby testing), but the response time for results need to be looked at. So >that is what she is working out now, finding out if the TBG results, when >marked URGENT can be returned sooner, so that there is not a too long >waiting time. Hopefully this can happen and a known inaccurate peice of >machinery can be removed! > >I hope this works out :) > >Jo > >Babies are Born... Pizzas are Delivered. -- This mailing list is sponsored by ACE Graphics. Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe.
