August 22, 2019

Baby Cafe USA is a national organization that offers free resources for pregnant and breastfeeding mothers.  In January 2018, the state's first Baby Cafe opened at Novant Health Thomasville Medical Center.  Not only have the staff at Thomasville committed to supporting breastfeeding, three other Baby Cafes have opened serving Novant patients in High Point, Charlotte, and Winston-Salem, with two more on the way in Lexington and Brunswick county.  The team at Thomasville took it a step further and have trialed a Hispanic Baby Cafe.

Initiating breastfeeding within the first sixty minutes of life as well as maintaining breastfeeding at discharge, are goals PQCNC teams across the state are working toward as they aim to optimally manage newborns at-risk for hypoglycemia.  Lisa R. Miller, IBCLC RLC, who leads the Baby Cafテゥ program at Thomasville is partnering with her inpatient nurse leaders to educate and empower moms who are at-risk for delivering a newborn with hypoglycemia and wish to exclusively breastfeed their baby.  

For more information on how you can start a Baby Cafe in your area, visit the website at http://www.babycafeusa.org 

July 18, 2019

PQCNC created a state-wide algorithm to kickoff the Newborn Hypoglycemia Prevention and Care initiative to assist teams with a strong resource as they began standardizing the care and management of newborns at-risk for hypoglycemia.  However, one team took it a step further. Understanding there were many scenarios and steps their staff would have to interpret when they rolled out the PQCNC algorithm, Vidant Medical Center saw an opportunity to ease implementation for their staff.  They added line items on the algorithm for staff to document blood glucose results, as well as time of testing and treatment if carried out. The document is not only a guide for standardization it is now a working algorithm to ensure the protocol produces an accurate clinical pathway every time.  The team also plans to collect these tools to track compliance and identify opportunities for further implementation support if necessary.


May 29, 2019

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.

April 30, 2019

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!

parent education material

April 5, 2019

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.

March 4, 2019

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. 

January 30, 2019

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

December 15, 2018

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. 

Register here to engage.

November 19, 2018

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:

AAP guidelines

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. 

October 18, 2018

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!