Hypoglycemia Protocol Notes

Weight-based:
- 2000-2500g: 1 ml
- 2502-3500g: 1.5 ml
- 3501-4500g: 2 ml
- 4501-5500g: 2.5 ml

Symptomatic/Cannot Feed:
- Feed within 30-60 minutes of birth (breast/chest/EHM or 5ml/kg ABM).
CBG < 2.6 mmol/L:
- Give dextrose gel 0.5ml/kg.
- Feed immediately (breast/chest/EHM or 5ml/kg ABM).
- Repeat CBG 30 minutes post-feed (within 60 minutes of previous).
Stable, Well, Can Feed, CBG ≥ 2.6 mmol/L:
- Feed every 2-3 hours.
- Check CBG pre-feed.

CBG ≥ 2.6 mmol/L:
- Continue feeding q2-3h, check CBG AC.
- When TWO consecutive pre-feed samples $\ge$ 2.6 mmol/L, Repeat AC q3-6 h until 12 hours of age for LGA/IDP or until 24 hours of age for LPT/SGA
CBG ≥ 1.8 and < 2.6 mmol/L:
- STAT CBG to lab.
- Give dextrose gel 0.5ml/kg.
- Supplement STAT with 5 ml/kg EHM or ABM.
- Notify MRP
- Repeat CBG 30 minutes post-feed (within 60 minutes of previous).
CBG < 1.8 mmol/L:
- Admit to NICU for IV D10W.
- Give dextrose gel 0.5ml/kg.
- Supplement 5ml/kg EHM/ABM immediately AND then breast/chest feed.

Jitteriness/tremors, cyanotic episodes, convulsions, apnea, tachypnea, weak/high-pitched cry, hunger, lethargy/limpness/hypotonia, feeding difficulty, eye rolling.
Rare: sweating, pallor, hypothermia, cardiac arrest/heart failure.