Donor breast milk has long been a staple of Neonatal Intensive Care Units to provide premature infants with the “next best thing” to mother’s milk. For many of the reasons donor breast milk is beneficial to premature infants, it is also beneficial to term infants. There are several challenges to utilizing donor breast milk in the Newborn Nursery population but Duke Regional Hospital has managed to successfully overcome them. Laura Zamora, an RN in Duke’s Lactation Services outlines the workflow surrounding management of donor breast milk and how it is utilized to supplement hypoglycemic infants in the Newborn Nursery at Duke Regional in a recorded presentation that you can find here. They have fully embraced that “breast is best” and provided donor breast milk as an option for all of their infants who need it.
Diagnosis of gestational diabetes (GDM), large for gestational age, small for gestational age and maternal use of beta-blockers, represent the most common risk factors threatening a newborn with hypoglycemia at birth. These maternal indications can largely be determined prior to delivery and therefore, beginning to partner with parents before birth is an optimal time to educate.
WakeMed Health and Hospitals, in Raleigh, decided to do just that. Working closely with their public relations department to convert the PQCNC parent education form to include their hospital logo, the team successfully produced two documents, one in English and one in Spanish. The nurse leaders on the postpartum floor then reached out to the leaders of the high-risk obstetric clinic and health department to educate them on the PQCNC project and goal they were trying to achieve. Aiming the education at mothers 26 weeks and greater, the clinic and health department have added the hypoglycemia documents to their current information packet. Once they deliver, the same education is presented again in the inpatient setting as well. Mothers with the above risk factors can now be aware of what to expect both before delivery and after.
We commend the WakeMed team for thinking outside the inpatient setting and beginning to partner with patients before birth to optimize the care provided to their newborns!
Treating and managing asymptomatic at-risk newborns for hypoglycemia relies on sticking to the basics - reinforcing the clinical skills of obtaining a heel-stick blood sample is one intervention some teams have deemed a priority. Utilizing the PQCNC video titled, “Proper Heel-stick Demonstration” and the PQCNC illustration outlining proper puncture site, teams are requiring their staff to view these resources prior to performing return demonstrations of the skill. Some teams have even added these informative tools to their annual education blitzes and new hire orientations to ensure continued competency with the skill. Though obtaining a heel-stick blood sample is a high-frequency clinical task performed daily, teams have recognized incorrect habits have formed over time potentially leading to inaccurate results. Going back to the basics and reviewing this critical task is helping to ensure the most accurate blood glucose sample is obtained, resulting in optimal management of the newborn at-risk.
With much evidence pointing to the benefits of glucose gel as a viable, effective, and inexpensive treatment option, teams across the state are giving it a go. Utilizing the PQCNC webinar resources available to them is proving useful - teams are sharing the videos on proper glucose gel administration with all staff to educate them on proper technique to achieve optimal glucose absorption. With baseline data showing over 60% of teams not using gel as a treatment option, the potential to improve care provided to newborns, keep moms and babies together, and promote breastfeeding efforts by our highly engaged teams is tremendous. The video is available on the NHPC webinar page to view at any time to support implementation efforts.
After months of review and numerous discussions, considering all current North Carolina algorithms and evidenced-based recommendations, the Newborn Hypoglycemia Prevention and Care collaborative achieved one of the primary goals teams desired: a statewide protocol for Management of At-Risk Newborns for Hypoglycemia.
Over 250 attendees at the initiative kickoff last week solidified these efforts and approved the document after careful review and expert engagement. Mirrored after the 2011 American Academy of Pediatric (AAP) version, the North Carolina statewide algorithm takes it a step further and includes the use of glucose gel as an intervention.
Blessed by Dr. David Adamkin himself, the author on the statement on Neonatal Hypoglycemia for the AAP, the resource is meant to provide teams with a standardized protocol right out of the gates, as we begin our work to improve care for the hypoglycemic newborn and those as risk.
Find it in Initiative Charter/Work Plans/Action Plans here
Hypoglycemia is one of the most frequently encountered problems in the first 48 hours of life and low glucose concentrations are perhaps the most common biochemical abnormality seen by providers caring for newborns. Unfortunately, the optimal strategy for managing this problem remains elusive. Now is the time to join the state in standardizing care for hypoglycemia of the newborn.
To date, there are over 60 teams who are registered for the kickoff meeting on January 24, 2019 in Raleigh. Are you one of them? If not, now is the time to engage.
A day of collaboration with teams across North Carolina and a talk by a national expert in the field, is not something to miss. Dr. David Adamkin, author of the statement on Neonatal Hypoglycemia for the American Academy of Pediatrics, will discuss the brewing topic of “Neonatal Hypoglycemia, Making Sense of Different Opinions” to kickoff PQCNC’s Newborn Hypoglycemia Prevention and Care initiative.
The first step in getting to where you want to go is knowing where you are.
*Is there a nurse driven standardized algorithm to guide clinical management of asymptomatic newborns at-risk for hypoglycemia at your facility?
*Current approach to management of the asymptomatic at-risk hypoglycemic newborn aligns with:
Pediatric Endocrine Society guidelines
Locally derived management protocol
*Is there an IV weaning protocol in your unit for infants who receive continuous IV therapy solely for the treatment of hypoglycemia?
These questions and more are serving as the basis for an intensive review of the current 'state' of care for hypoglycemia. Comparing that state with identified best practices is part of the baseline work teams are undertaking to identify possible areas of improvement and prepare for the work ahead.
There are less than 100 days before the January 24, 2019 kickoff meeting where teams will develop their plan for success. If you are excited to collaborate, enthusiastic to share resources, and eager to engage in a project aimed at improving outcomes for newborns while keeping the mom and baby together then click here and register your team to begin preparations and commence PQCNC support!
The Newborn Hypoglycemia Prevention and Care expert team decided developing a statewide hypoglycemia protocol to manage the at-risk newborn should be a goal of this project. Utilizing evidenced-based practice and tapping into the expert knowledge of our providers across the state is how we plan to accomplish this.
If your unit currently has a hypoglycemia protocol or algorithm that guides clinical practice, please consider sharing it with PQCNC. Your unit practices will help develop a statewide clinical algorithm to help standardize care for newborns in North Carolina. Submit your algorithm here
If you are a hospital interested in improving your process of identifying and treating symptomatic and at-risk newborns for hypoglycemia within the first 48 hours of life, now is the time to join the effort. Go here, download the guide, and get started - once your team is registered, the PQCNC leadership team will support you over the next few months to ensure your team is prepared for success prior to kickoff.