Next Newborn / Neonatal Initiative

Neonatal Hypoglycemia Care & Prevention

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.