Tracking tool to support Hypoglycemia protocol implementation - PQCNC was proud to partner with Catherine Bennett CNS, from Advocate Lutheran General Hospital in Illinois, to bring North Carolina teams this supportive tool to measure compliance of how well your unit hypoglycemia at-risk algorithm is being followed. Simple instructions to optimize use of the tool are as follows:
Simple instructions to optimize use of the tool are as follows:
- Ensure nurses caring for at-risk hypoglycemic newborns are educated on the tool (they will own the success of this process)
- Instruct them to introduce the tool to parents of the at-risk newborn, taking the time to outline why the tool is important, why they are monitoring their newborn and the importance of them calling the nurse prior to feeding so a pre-prandial glucose level can be obtained. (excellent opportunity to educate family)
- Each time a feeding and/or intervention occurs, it should be documented on the tool
- Once newborn is discharged, no longer being monitored or transferred for higher acuity care, the form should be collected and reviewed
Dextrose gel for neonatal hypoglycaemia (the Sugar Babies Study): a randomised, double-blind, placebo-controlled trial - This seminal article has shaped the management of neonatal hypoglycemia. This study out of New Zealand recommends treatment with dextrose gel be considered the first-line treatment to manage hypoglycemia in late preterm and term babies in the first 48 hours after birth. The authors concluded dextrose gel is inexpensive, simple to administer and can successfully reverse newborn hypoglycemia.
Neonatal hypoglycemia, defined as a plasma glucose level of less than 30 mg/dL (1.65 mmol/L) in the first 24 hours of life and less than 45 mg/dL (2.5 mmol/L) thereafter, is the most common metabolic problem in newborns. Major long-term sequelae include neurologic damage resulting in mental retardation, recurrent seizure activity, developmental delay, and personality disorders. Some evidence suggests that severe hypoglycemia may impair cardiovascular function.
Outcome at two years after dextrose gel treatment for neonatal hypoglycemia; Follow up of a randomized trial - This follow up study to the Sugar Babies paper confirms that treatment with dextrose gel is not associated with additional risks or benefits at two years of age. The authors claim that clinicians and families can be reassured that the advantages of treatment with dextrose gel soon after birth are not counterbalanced by increased risk of poor neurodevelopmental outcomes at two years’ corrected age.
Clinical Report—Postnatal Glucose Homeostasis in Late-Preterm and Term Infants - Published in Pediatrics, this report provides a practical guide and algorithm for the screening and subsequent management of neonatal hypoglycemia. Highlighting the fact that no rigorous scientific definition has been reached, this influential article from 2011, continues to be endorsed today as the guidelines to manage neonatal hypoglycemia by the American Academy of Pediatrics.
Early skin-to-skin contact for mothers and their healthy newborn infants. - This extensive Cochrane review discusses the general consensus that “minimally, skin to skin contact should continue until the end of the first successful breastfeeding in order to show an effect and to enhance early infant self-regulation.” Cited in this article as one of the common reasons for separation is hypoglycemia. The review highlights evidence for a clinically meaningful increase in blood glucose in infants who received skin to skin contact and goes on to say that even if practiced for a “short time at birth [skin to skin contact] should have measurable breastfeeding effects one to four months’ post birth.”
New approaches to management of neonatal hypoglycemia. - This very informative article focuses on the role of buccal dextrose gel in the management of asymptomatic neonatal hypoglycemia and encourages the use of dextrose gel as part of a treatment protocol. Additionally, the authors support the abandonment of the intravenous dextrose bolus for the treatment of asymptomatic, hypoglycemic late preterm, LGA, SGA/IUGR, and IDM newborns.