General Meeting November 2018 Neonatal Hypoglycemia Background
• 30% of infants at risk
– Likely to increase given rising maternal diabetes • 10% requiring intensive care • Estimated to cost $2.1 billion annually • Mother/infant separation • Often decreased breastfeeding/lactogenisis • Highly variable practice from cut-off values for treatment and method of treatment Initiative Aim
• Reduce NICU transfers for asymptomatic hypoglycemia
• Maintain mother/infant dyad • Support breastfeeding • Reduce healthcare costs • Key Measures to track – NICU transfers for hypoglycemia – Rates of IV Dextrose – SSC rates – Early feeding rates – Supplementation rates – Breast feeding rates at discharge Initiative Impact
• Utilizes free and most natural resource – MOM
• Goal is to maintain family unit – Decreases family stress – Involves family in newborn’s care • Ideally educate and empower families prenatally to care for their at-risk infants • Promotes best practice per AAP and focuses on prevention • Low cost initiative, utilizes existing staff & family Reasons to continue the current Newborn Initiative • Finding methods for each system to accurately identify & track all infants at risk for hypoglycemia can take some time and trial and error • Incorporating all stakeholders (NICU, NBN, L&D, Lactation, Post- partum) • Can take time to get feedback/involvement from all parties • Can identify systems issues that need to be addressed • For many staff it is a culture shift that takes time to occur P-chart chart of hypoglycemia project at UNC showing ~4 month lag time between project initiation and change in NICU admissions Continuing the Newborn Hypoglycemia Care & Prevention Initiative for another year would…
• Allow time for troubleshooting required in any new project
• Allow centers to order and incorporate use of dextrose gel if not already utilizing • Encourage involvement & allow time for culture shift that creates an environment for lasting improvement References • Adamkin DH, Polin RA. Imperfect advice: Neonatal hypoglycemia. J Pediatr. 2016;176:195- 196 • Chertok IR, Raz I, Shoham I, Haddad H, Wiznitzer A. Effects of early breastfeeding on neonatal glucose levels of term infants born to women with gestational diabetes. J Hum Nutr Diet. 2009;22(2):166-169 • Committee on Fetus and Newborn, Adamkin DH. Postnatal glucose homeostasis in late- preterm and term infants. Pediatrics. 2011;127(3):575-579. • Moore ER, Bergman N, Anderson GC, Medley N. Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database Syst Rev. 2016;11:CD003519 • Vila-Candel R, Duke K, Soriano-Vidal FJ, Castro-Sanchez E. Effect of early skin-to-skin mother- infant contact in the maintenance of exclusive breastfeeding. J Hum Lact. 2017:890334416676469. • Wight N, Marinelli KA, Academy of Breastfeeding Medicine. ABM clinical protocol #1: Guidelines for blood glucose monitoring and treatment of hypoglycemia in term and late- preterm neonates, revised 2014. Breastfeed Med. 2014;9(4):173-179.