An 8.5 lb, 6 oz infant is delivered to a diabetic mother. Which nursing intervention would be implemented when the neonate becomes jittery and lethargic?
A. Administer insulin.
B. Administer oxygen.
C. Feed the infant glucose water (10%).
D. Place the infant in a warmer.
Correct Answer: C. Feed the infant glucose water (10%)
After birth, the infant of a diabetic mother is often hypoglycemic. Treatment will depend on the baby’s gestational age and overall health. Treatment includes giving the baby a fast-acting source of glucose. This may be as simple as a glucose and water mixture or formula as an early feeding. Or the baby may need glucose given through an IV. The baby’s blood glucose levels are checked after treatment to see if the hypoglycemia occurs again.
Option A: Second-line therapies for the treatment of persistent hypoglycemia include the use of corticosteroids or glucagon, not insulin. Glucagon is a hormone that stimulates endogenous glucose production via glycogenolysis and gluconeogenesis; thus its effectiveness depends on the infant having adequate glycogen stores. It is most useful in term infants and infants of diabetic mothers. Glucagon dosing is as a 30 mcg/kg bolus or 300 mcg/kg per minute continuous infusion.
Option B: Oxygen is not administered to hypoglycemic neonates. Early initiation of breastfeeding is crucial for all infants. For asymptomatic infants at risk of neonatal hypoglycemia, the AAP recommends initiating feeds within the first hour of life and performing initial glucose screening 30 minutes after the first feed. The AAP recommends goal blood glucose levels equal to or greater than 45 mg/dL prior to routine feedings, and intervention for blood glucose <40 mg/dL in the first 4 hours of life and <45 mg/dL at 4 to 24 hours of life.
Option D: Placing the infant in a warmer does not manage the hypoglycemia. In infants of diabetic mothers, lower glucose infusions rates of 3 to 5 mg/kg/minute may be used to minimize pancreatic stimulation and endogenous insulin secretion. Infants requiring higher rates of intravenous dextrose (>12 to 16 mg/kg/minute) or for more than 5 days are more likely to have a persistent cause of hypoglycemia.