279 - The Impact of Real-World Implementation of Oral Dextrose Gel for Management of Neonatal Hypoglycemia in the Well Newborn Nursery

Friday, April 28, 2023

5:15 PM – 7:15 PM ET

Poster Number: 279
Publication Number: 279.131

Lakshmy Vaidyanathan, University of Texas at Austin Dell Medical School, Austin, TX, United States; Komal Vargas, Pediatrix/Affiliate Faculty/UT Dell Medical School, Round Rock, TX, United States; Jianzhong Ji, Dell Children's Medical Center of Central Texas, Cedar park, TX, United States; Vaibhav Bhamidipati, Dell Children's Medical Center of Central Texas, Austin, TX, United States; Alan Groves, University of Texas at Austin Dell Medical School, Austin, TX, United States; Davika Reid, University of Texas at Austin Dell Medical School, Austin, TX, United States

Presenting Author(s)

Lakshmy Vaidyanathan, MD FAAP FABM IBCLC (she/her/hers)

Assistant Professor of Pediatrics
University of Texas at Austin Dell Medical School
Austin, Texas, United States

Background:

Recurrent & sustained periods of postnatal hypoglycemia can lead to neuronal injury in newborns. Several maternal & infant risk factors predispose some newborns to hypoglycemia; therefore, screening & treatment protocols in the newborn nursery are necessary to identify & treat those at-risk. Provision of 40% dextrose gel (DG) has been shown to improve outcomes in infants with risk factors for hypoglycemia in the setting of randomized clinical trials (RCT). Clinical implementation outside of an RCT does not consistently show an equivalent impact of intervention.

Objective: To evaluate implementation of DG for management of postnatal hypoglycemia in newborn nursery infants in the ‘real world’ setting.

Design/Methods:

In this single center cohort study, we conducted a retrospective chart review of 738 at-risk infants in 2 cohorts, before DG implementation (April 2019 - July 2019) and after DG implementation (April 2020 - July 2020). We included all at-risk infants who were placed on the Newborn Hypoglycemia Screening protocol. Risk factors included late prematurity (35 0/7- 36 6/7 weeks), birth weight < 2500 grams or >4000 grams, any maternal diabetes, or intrapartum terbutaline administration. Infant outcomes were presence of any hypoglycemia, mean blood glucose level in the infants who developed hypoglycemia, number of hypoglycemic events, and need for NICU transfer. Continuous parametric and non-parametric data were compared by t-test and Krushkal-Wallis respectively.

Results: The mean gestational age of both cohorts was 38+3 weeks(Table 1). There were 385 and 353 at-risk newborns in the pre- and post-DG cohorts respectively. 147 (38%) and 112 (41%) developed hypoglycemia. Mean glucose for infants who developed hypoglycemia were 37 and 35 respectively (p=0.05). Median number of hypoglycemic events was zero in both groups, but infants in the post-DG group had fewer episodes (Table 1, p=0.04). There was no difference in the rate of NICU admissions (7% vs 9%, p=0.28).

Conclusion(s):

Implementation of dextrose gel protocol for at- risk newborns in the postnatal nursery can significantly reduce the number of hypoglycemic episodes but may not reduce the number of NICU admissions.
Hypoglycemia study-Table 1.jpeg