IV Fluids in the

Mother Baby Unit

Meghan Dougherty, MD
§ NewHanover Regional Medical Center in
Wilmington, NC
§ Betty
H. Cameron Women’s and Children’s Hospital
opened in 2008
§ Over 4,000 deliveries per year
§ 35 beds for couplet care
§ 45 NICU beds
§ 17 pediatric floor beds
§6 PICU beds
Neonatal care providers
§6 full time neonatologists and 10 NNPs
§6 pediatric hospitalists and 4 pediatric nurse
practitioners from Coastal Children’s Services
§ 10 community pediatricians
§ NHRMC Coastal Family Medicine Residency Program
§ D10W at 3 ml/kg/hr to deliver GIR 5 mg/kg/min
§ Continue until AC glucose greater than 45 mg/dL x 3
§ Wean by 2 ml/hr with each feeding if AC glucose is
greater than 45 mg/dL

§ Average weaning time 20-24 hours

 2019
NICU
Hypoglycemia IV Weaning
Protocol
 IV Weaning Protocol for Newborns with Hypoglycemia
(for infants <48 hours of age and failed PO algorithm in well baby nursery including glucose gel x 3 doses)

NICU Blood Glucose <45 MG/DL and Symptomatic NICUBlood Glucose <45 MG/DL and Asymptomatic

Bolus of 2mL/kg of D10W over 5 min

Begin D10W @ 60-80 mL/kg/d (Glucose Infusion Rate (GIR) 4-6 mg/kg/min)

CONSIDERATIONS:
Recheck BG 30 minutes after initiation of D10W 1. Infants with multiple risk factors or inability to adequately feed will
likely require higher GIR
2. At 100mL/kg/d of D10W (GIR = 7 mg/kg/min) consider D12.5W,
if GIR requirements continue to increase, consider central line
Recheck BG 60 minutes after any Recheck BG in 3 hours (AC with
(UVC) if greater dextrose concentration than D12.5W is needed
increase in GIR until target BG PO feeds) with any hold or
achieved decrease in GIR 3. If blood glucose not improving despite D10W bolus and dextrose
infusion, consider continuous NG/OG drip feeds due to
TARGET BG ≥45 MG/DL for infants <24 hours of age and ≥50 MG/DL possibility of hyperinsulinemia until glucoses stabilize
for infants 24-48 hrs of age
4. Titration guidelines should not be used if GIR requirements exceed
ADJUST RATE AS FOLLOWS: See order in Cerner for IV rates associated with GIR 10-12 mg/kg/min
5. If escalation in GIR is needed or if hypoglycemia recurs with
BG<30 Call NNP, Physician & increase
decreasing GIR, consider holding at previous GIR for 6 hours
GIR by 2 mg/kg/min
before next attempt to decrease
BG 30-44 Increase GIR by 1 mg/kg/min 6. After IV fluids are discontinued, newborn should have 3 consecutive

BG 45-60 No change glucose levels > 50 mg/dl if <48 hrs old and >60 mg/dl if >48 hrs old
before transfer to NBN or discharge.
BG>60 Decrease GIR by 1 mg/kg/min
7. Lowest IV rates: 1 ml/hr via PIV and 1.5 ml/hr via UVC; call
BG>75 Decrease GIR by 2 mg/kg/min Physician or NNP if having difficult IV access
 IV Weaning Protocol for Newborns with Hypoglycemia
(for infants <48 hours of age who failed PO algorithm in well
baby nursery including glucose gel x 3 doses) Considerations:
Initial BG < 45 and Initial BG < 45 and • Infants with multiple risk factors or inability to
symptomatic asymptomatic adequately feed will likely require higher GIR
Bolus of 2mL/kg of D10W • At 100mL/kg/d of D10W (GIR = 7 mg/kg/min) consider
over 5 min (requires order) D12.5W, if GIR requirements continue to increase,
Begin D10W as ordered Begin D10W as ordered consider central line (UVC) if greater dextrose
60-80 mL/kg/d 60-80 mL/kg/d concentration than D12.5W is needed
Glucose Infusion Rate (GIR) Glucose Infusion Rate (GIR) • If blood glucose not improving despite D10W bolus and
4-6 mg/kg/min 4-6 mg/kg/min) dextrose infusion, consider continuous NG/OG drip
Bedside Recheck BG 30 minutes after initiation of D10W
TARGET BG ≥45 MG/DL for infants <24 hours of age and
feeds due to possibility of hyperinsulinemia until
glucoses stabilize
Card ≥50 MG/DL for infants 24-48 hrs of age
ADJUST RATE AS FOLLOWS:
• Titration guidelines should not be used if GIR
*See order in Cerner for IV rates associated with GIR requirements exceed 10-12 mg/kg/min
• If escalation in GIR is needed or if hypoglycemia recurs
BG < 30: Call NNP/Physician. Increase GIR by 2 mg/kg/min*
with decreasing GIR, consider holding at previous GIR
BG 30-44: Increase GIR by 1 mg/kg/min* for 6 hours before next attempt to decrease
BG 45-60: No change
• After IV fluids are discontinued, newborn should have 3
BG > 60: Decrease GIR by 1 mg/kg/min*
consecutive glucose levels > 45 mg/dl if <48 hrs old and
BG >75: Decrease GIR by 2 mg/kg/min* >60 mg/dl if >48 hrs old before transfer to NBN or
• Recheck BG 60 minutes after any increase in GIR until discharge
target BG achieved
• Recheck BG in 3 hours (AC with PO feeds) with any • Lowest IV rates: 1 ml/hr via PIV and 1.5 ml/hr via UVC;
hold or decrease in GIR call Physician or NNP if having difficult IV access
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