A feed-centric hypoglycaemia pathway ensures appropriate care escalation in at-risk infants

BackgroundThere is a lack of clarity of what constitutes the starting point of a clinical pathway for infants at-risk of hypoglycaemia. Glucose-centric pathways (GCP) identify low glucose in the first 2 hours of life that may not represent clinical hypoglycaemia and can lead to inappropriate glucose...

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Bibliographic Details
Published in:BMJ open quality 2021-12, Vol.10 (4), p.e001296
Main Authors: Chandran, Suresh, Siew, Jia Xuan, Rajadurai, Victor Samuel, Lim, Rachel Wei Shan, Chua, Mei Chien, Yap, Fabian
Format: Article
Language:English
Subjects:
Asymptomatic
Birth weight
Body mass index
Breastfeeding & lactation
Diabetes
diabetes mellitus
Gestational age
Glucagon
Glucose
healthcare quality improvement
Hospitalization
Humans
Hypoglycemia
Hypoglycemia - diagnosis
Hypoglycemia - epidemiology
Infant, Newborn
Mothers
Newborn babies
Nurses
paediatrics
Pediatrics
Physiology
Quality control
Quality improvement
Quality Improvement Report
Skin care
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Summary:BackgroundThere is a lack of clarity of what constitutes the starting point of a clinical pathway for infants at-risk of hypoglycaemia. Glucose-centric pathways (GCP) identify low glucose in the first 2 hours of life that may not represent clinical hypoglycaemia and can lead to inappropriate glucose management with infusions and medications.ObjectiveTo study the impact of a feed-centric pathway (FCP) on the number of admissions for hypoglycaemia to level 2 special care nursery (SCN) and the need for parenteral glucose/medications, compared to GCP.MethodsThis project was conducted over 2 years, before and after switching from a GCP to FCP in our institution. FCP involves skin-to-skin care, early breast feeding, checking glucose at 2 hours and use of buccal glucose. The primary outcome was the number of SCN admissions for hypoglycaemia. Secondary outcomes include the number of infants needing intravenous glucose, medications and length of SCN stay.ResultsOf 23 786 live births, 4438 newborns were screened. We screened more infants at-risk for hypoglycaemia using the FCP (GCP:1462/11969, 12.2% vs FCP:2976/11817, 25.1%) but significantly reduced SCN admissions (GCP:246/1462, 16.8% vs FCP:102/2976, 3.4%; p
ISSN:2399-6641
2399-6641
DOI:10.1136/bmjoq-2020-001296