A nurse assesses a 2-hour-old neonate born to a mother with gestational diabetes. The blood glucose is 38 mg/dL. The infant is jittery and has a weak cry. What is the priority nursing action?
- A.Recheck blood glucose in 1 hour before taking any action
- B.Initiate early breastfeeding or formula feeding and recheck glucose in 30 minutes
- C.Administer IV dextrose bolus immediately per standing order
- D.Warm the infant and swaddle to improve glucose by raising metabolic rate
Show answer & rationale
Correct answer
B. Initiate early breastfeeding or formula feeding and recheck glucose in 30 minutes
Rationale
B is correct: A blood glucose of 38 mg/dL in the first hours of life is below the common threshold for neonatal hypoglycemia (typically <45-47 mg/dL in the first hours per most protocols). With symptoms (jitteriness, weak cry), the first intervention for a stable, feeding-capable infant is early oral feeding (breast or formula). This provides glucose substrate without the risks of IV access. The glucose must be rechecked after feeding per protocol. A is incorrect: Waiting 1 hour in a symptomatic hypoglycemic newborn risks seizure and neurological injury. C is incorrect: IV dextrose is reserved for severe hypoglycemia, infants who cannot feed, or those who fail to respond to oral feeding. It is not the first step in a stable, symptomatic newborn. D is incorrect: Warming addresses cold stress but does not directly treat hypoglycemia; metabolic rate increases also increase glucose demand.
Key concepts