Implementation of clinical practice guideline for newborn infants at risk of neonatal hypoglycemia
Keywords:
ืnewborn, hypoglycemia, clinical practice guideline, infant at risk, infant of diabetic motherAbstract
Context: There are various recommendations for identification, monitoring, and management of newborn infants at risk of neonatal hypoglycemia.
Objectives: To compare the incidence of symptomatic hypoglycemia before and after implementation of clinical practice guideline (CPG) for newborn Infants at risk of neonatal hypoglycemia.
Methods: A retrospective cohort study and Pre-Post analysis was conducted in newborn infants born between July 2019 and June 2021 at Burapha University Hospital, Chonburi, Thailand. The newborn infants at risk were divided into 2 groups by date of birth: 1-year before CPG implementation (Pre-CPG) group and 1-year after CPG implementation (Post-CPG) group. The incidence of symptomatic hypoglycemia between two groups of newborn infants was compared by retrospective chart review.
Results: There were 187 participants enrolled to the study. Eighty-two infants were categorized to the Pre-CPG group and 105 infants to the Post-CPG group. The incidence of symptomatic hypoglycemia in the Post-CPG group was significantly lower than the Pre-CPG group (1.9% vs. 9.8%, RR=0.20, 95%CI=0.04-0.89, p=0.04). Furthermore, the incidence of asymptomatic hypoglycemia in the Post-CPG group was significantly lower than the Pre-CPG group (1.9% vs. 15.9%, RR=0.12, 95%CI=0.03-0.52, p=0.004).
Conclusions: Implementation of clinical practice guideline (CPG) for newborn Infants at risk of neonatal hypoglycemia can reduce the incidence of symptomatic and asymptomatic hypoglycemia in newborn infants at risk of neonatal hypoglycemia. This CPG focused on early feeding the newborn infants at risk to prevent hypoglycemic symptoms and modulated blood glucose cut-off value for diagnosis of neonatal hypoglycemia.
Keywords: hypoglycemia, newborn, practice guideline
References
Thompson-Branch A, Havranek T. Neonatal hypoglycemia. Pediatr Rev. 2017; 38: 147-57.
Harris DL, Weston PJ, Harding JE. Incidence of neonatal hypoglycemia in babies identified as at risk. J Pediatr. 2012; 161: 787-91.
McKinlay CJ, Alsweiler JM, Anstice NS, Burakevych N, Chakraborty A, Chase JG, et al. Association of neonatal glycemia with neurodevelopmental outcomes at 4.5 years. JAMA Pediatr. 2017; 171: 972-83.
Shah R, Harding J, Brown J, McKinlay C. Neonatal glycaemia and neurodevelopmental outcomes: a systematic review and meta-analysis. Neonatology. 2019; 115: 116-26.
Cornblath M, Hawdon JM, Williams AF, Aynsley-Green A, Ward-Platt MP, Schwartz R, et al. Controversies regarding definition of neonatal hypoglycemia: suggested operational thresholds. Pediatrics. 2000; 105: 1141-5.
Adamkin DH. Clinical Report—Postnatal Glucose Homeostasis in late-preterm and term infants. Pediatrics. 2011; 127: 575-9.
Thornton PS, Stanley CA, De Leon DD, Harris D, Haymond MW, Hussain K, et al. Recommendations from the Pediatric Endocrine Society for evaluation and management of persistent hypoglycemia in neonates, infants, and children. J Pediatr. 2015; 167: 238-45.
Narvey MR, Marks SD. The screening and management of newborns at risk for low blood glucose. Paediatr. Child Health. 2019; 24: 536-44.
Sangsawang T, Roonghiranwat T. Incidence and risk factor of hypoglycemia in high risk infant in neonatal unit of Prapokklao hospital, Chantaburi. J Prapokklao Hosp Clin Med Educat Center. 2018; 35: 268-76.
Hosagasi NH, Aydin M, Zenciroglu A, Ustun N, Beken S. Incidence of hypoglycemia in newborns at risk and an audit of the 2011 American academy of pediatrics guideline for hypoglycemia. Pediatr Neonatol. 2018; 59: 368-74.
Cordero L, Ramesh S, Hillier K, Giannone PJ, Nankervis CA. Early feeding and neonatal hypoglycemia in infants of diabetic mothers. SAGE Open Med. 2013; 1: 2050312113516613.
McKinlay CJ, Alsweiler JM, Ansell JM, Anstice NS, Chase JG, Gamble GD, et al. Neonatal glycemia and neurodevelopmental outcomes at 2 years. N Engl J Med. 2015; 373: 1507-18.
van Kempen AA, Eskes PF, Nuytemans DH, van der Lee JH, Dijksman LM, van Veenendaal NR, et al. Lower versus traditional treatment threshold for neonatal hypoglycemia. N Engl J Med. 2020; 382: 534-44.
Meneghin F, Manzalini M, Acunzo M, Daniele I, Bastrenta P, Castoldi F, Cavigioli F, Zuccotti GV, Lista G. Management of asymptomatic hypoglycemia with 40% oral dextrose gel in near term at-risk infants to reduce intensive care need and promote breastfeeding. Ital J Pediatr. 2021; 47: 1-8.
Sen S, Andrews C, Anderson E, Turner D, Monthé-Drèze C, Wachman EM. Type of feeding provided with dextrose gel impacts hypoglycemia outcomes: comparing donor milk, formula, and breastfeeding. J Perinatol. 2020; 40: 1705-11.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2022 Burapha Journal of Medicine
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
