Decreasing early hypoglycemia frequency in at-risk newborns after implementing a new hypoglycemia screening algorithm

• Published in: Journal of perinatology Vol. 41; no. 12; pp. 2840 - 2846
• Main Authors: Sivarajan, Muraleedharan, Schneider, Joseph H., Johnson, Kathryn A., Bai, Shasha, ElHassan, Nahed O., Kaiser, Jeffrey R., Nelson, David B., Brown, Larry S., Burchfield, Patti J., Brion, Luc P.
• Format: Journal Article
• Language: English
• Published: New York Nature Publishing Group US 01-12-2021; Nature Publishing Group
• Subjects: 692/163/2743; 692/700/1720; Age; Algorithms; Birth weight; Blood Glucose; Care and treatment; Child development deviations; Complications and side effects; Developmental disabilities; Female; Gestational Age; Glucose; Growth curves; Health aspects; Humans; Hypoglycemia; Hypoglycemia - diagnosis; Hypoglycemia - epidemiology; Hypoglycemia - prevention & control; Infant, Newborn; Infant, Newborn, Diseases; Infants (Premature); Medicine; Medicine & Public Health; Neonates; Newborn babies; Optimization; Pediatric research; Pediatric Surgery; Pediatrics; Prevention; Quality control; Quality Improvement Article; Risk factors; Screening; Small for gestational age; United States
• ISSN: 0743-8346; 1476-5543
• DOI: 10.1038/s41372-021-01263-8

Background
Neonatal hypoglycemia may affect long-term neurodevelopment.
Methods
Quality improvement (QI) initiative for Mother-Baby-Unit (MBU) admissions (birthweight ≥ 2100 g; ≥35 weeks’ gestation) over two epochs from 2016–2019 to reduce the frequency of early (≤3 h) neonatal hypoglycemia in small and large newborns.
Intervention
New algorithm using Olsen’s growth curves, hypoglycemia thresholds of <2.22 mmol/L [40 mg/dL] (0–3 h) and <2.61 mmol/L [47 mg/dL] (>3 to 24 h), feeding optimization and 24-hour glucose checks for small for gestational age and preterm newborns.
Results
Among 39,460 newborns, using subsets with identical screening criteria, early hypoglycemia decreased significantly after QI implementation among large for gestational age newborns with birthweight >3850 g (66%) and small for gestational age newborns with birthweight <2500 g (70%). Among all MBU admissions, the adjusted odds of any hypoglycemia in 24 h decreased (
P
 < 0.001).
Conclusions
Feeding optimization may decrease early hypoglycemia frequency in large and small newborns.