Health e-Learning-IIHL also had a wonderful experience this past June attending La Grande Conférence de l’Association québécoise des consultantes en lactation (AQC) (Quebec Lactation Consultant Association Big Conference) in our home town of Montreal. Merci à tous les IBCLC et d'autres professionnels de la santé qui nous ont accueillis. Thank you to all the IBCLCs and other health care professionals that welcomed us. We also chatted with many of our past students who were excited to see the French LP14 up and running as well as learning that we are slowly translating all the BreastEd courses into French which will be excellent for our francophone distance learners.
This month we would like to share with you the updated Academy of Breastfeeding Medicine, Clinical Protocol #1. Guidelines for Blood Glucose Monitoring and Treatment of Hypoglycemia in Term and Late-Preterm Neonates, Revised 2014. All the clinical protocols from the Academy of Breastfeeding Medicine are excellent resources for clinical use. ABM Protocol # 1 was developed to help provide guidance in those ﬁrst hours/days of life so as to prevent clinically signiﬁcant hypoglycemia in infants, appropriately monitor blood glucose levels in at-risk term and late-preterm infants, manage documented hypoglycemia in infants, and to establish and preserve maternal milk supply during medically necessary supplementation for hypoglycemia or during separation of mother and baby.
This is an excellent guide to share with colleagues, as provides both guided care plans and treatment plans. The document clarifies general management recommendations for all term infants including early and exclusive breastfeeding as well as skin to skin contact and no routine supplementation for healthy term newborn infants. Here is the summary from the ABM clinical protocol #1.
Healthy term infants are programmed to make the transition from their intrauterine constant flow of nutrients to their extrauterine intermittent nutrient intake without the need for metabolic monitoring or interference with the natural breastfeeding process. Homeostatic mechanisms ensure adequate energy substrate is provided to the brain and other organs, even when feedings are delayed. The normal pattern of early, frequent, and exclusive breastfeeding meets the needs of healthy term infants.
Routine screening and supplementation are not necessary and may harm the normal establishment of breastfeeding. Current evidence does not support a specific blood concentration of glucose that correlates with signs or that can predict permanent neurologic damage in any given infant. At-risk infants should be screened, followed up as needed, and treated with supplementation or IV glucose if there are clinical signs or suggested thresholds are reached.
Bedside screening is helpful, but not always accurate, and should be confirmed with laboratory glucose measurement. A single low glucose value is not associated with long-term neurological abnormalities, provided the treating clinician can be assured that the baby was entirely well up until the time of the low value. Hypoglycemic encephalopathy and poor long-term outcome are extremely unlikely in infants with no clinical signs and are more likely in infants who manifest clinical signs and/or with persistent or repeated episodes of severe hypoglycemia.
As Hypoglycemia is an interesting subject we hope you enjoy this expert lecture - XL16: "Martin Ward-Platt: Neonatal Hypoglycaemia - Evidence and Recommendations"