Category: Professional Posters
Purpose: Neonatal hypoglycemia may require interventions which interfere with mother-baby bonding and breastfeeding, including formula feeding, intravenous dextrose, and neonatal intensive care. Oral glucose gel is a non-invasive, inexpensive intervention, to quickly correct hypoglycemia. The neonatal hypoglycemia protocol at a community-based hospital was updated to include primary treatment with oral glucose gel. Goals included decreasing other interventions and increasing likelihood of breastfeeding in hospital and per discharge feeding plan. Threshold for treatment was changed from glucose less than 36 mg/dL to less than 41 mg/dL. The purpose of this study was to evaluate the effects of the protocol change.
Methods: The institutional review board approved this retrospective chart review study. Glucose results for newborns admitted prior to (8/1/17 through 1/31/2018, Timeframe I) and after protocol change (8/1/2018 through 1/31/2019, Timeframe II) were reviewed. Neonates under well newborn care with initial glucose less than 36 mg/dL and less than 41 mg/dL were included based on the respective hypoglycemia protocol. Patients were excluded if they were delivered outside of the hospital’s labor and delivery unit or admitted to neonatal intensive care at the time of glucose check. Mean initial glucose result, time to first glucose, qualifiers for glucose screening, first feeding within one hour of birth, type of first feeding, exposure to any formula or donor milk during admission, and discharge feeding plan were evaluated. Additionally, adherence to the corresponding neonatal hypoglycemia protocol was reviewed, including time to primary treatment (feeding in Timeframe I and glucose gel in Timeframe II) and time to glucose recheck. Subsequent admission to neonatal intensive care and administration of intravenous dextrose were evaluated. Study results were not evaluated for statistical significance, but were descriptive in nature.
Results: A total of 868 charts were reviewed. Fourteen patients met criteria for hypoglycemia treatment in each group. Average initial glucose result, time to first glucose, qualifiers for glucose screening, first feeding within one hour of birth, type of first feeding, and admission to neonatal intensive care were similar between the two groups. Thirteen neonates in Timeframe I were exposed to formula or donor milk during admission, while 8 patients were in Timeframe II. The number of patients with discharge feeding plan of breastmilk increased from 2 patients in Timeframe I to 7 patients in Timeframe II. Discharge feeding plan of formula was similar between groups, with 3 patients in Timeframe I and 2 patients in Timeframe II. Combination feeding plan decreased from 9 patients to 5 patients. Intravenous dextrose was administered to 4 patients in Timeframe I and 1 patient in Timeframe II. Mean time to primary treatment, as well as mean time to recheck glucose decreased from 66 to 22 minutes and 106 to 83 minutes, respectively.
Conclusion: Change in neonatal hypoglycemia protocol to include oral glucose gel as the primary treatment demonstrated a decrease in mean time to primary treatment and glucose recheck. Fewer neonates were exposed to formula or donor milk during their hospital admission and an increase was seen in the number of neonates discharged with breastmilk as the feeding plan. Use of intravenous dextrose was lower in the oral glucose gel group as well. Further study involving a larger patient group would be necessary to determine statistical significance.