189 - Introducing dextrose gel in conjunction with feeding to treat asymptomatic hypoglycemia in high risk newborn group

Poster Number: 189
Publication Number: 189.439

Shafa Eloud, MetroHealth system, Westlake, OH, United States; Muhanad Bensaleem, BronxCare Health System, Bronx, NY, United States; Aimary Marino, Bronx Care Health System, Bronx, NY, United States; Meriam J. Avades, BronxCare Health System, New York, NY, United States; Saranya Radhakrishnan, Bronxcare Health System, Jamaica, NY, United States; Pratibha Ankola, Icahn School of Medicine at Mount Sinai, Bronx, NY, United States

Background: Neonatal hypoglycemia (NH) is seen in 5-15% of healthy newborns and 50% of high-risk newborns, which include infants of diabetic mothers (IDM), small or large for gestational age (SGA, LGA), or late preterm (PT) infants. The initial fall of blood glucose may persist in some infants and has the potential to cause permanent neurologic damage. In current practice, early feeding is the preventative approach to NH. When NH does not resolve with feeding alone, management includes admission to the neonatal intensive care unit (NICU) for intravenous (IV) dextrose.
Researchers are increasingly interested in introducing dextrose gel as a treatment for asymptomatic NH in the newborn nursery. Multiple studies have evaluated its role and found it to be safe, effective, and well-tolerated.
Prior to this quality improvement (QI) initiative, all infants with hypoglycemia in the BronxCare Health System (BCHS) were admitted to the NICU for IV dextrose. Our project seeks to evaluate effectiveness of dextrose gel in correcting asymptomatic NH in newborns. This will facilitate maternal-infant bonding and breastfeeding in neonates who will continue to room in with their mothers. It will also decrease admissions to NICU, cost of medical care, and provider workload.

Objective: The aim of this QI project is to decrease the asymptomatic NH admission rate to the NICU at BCHS to 25% by June 2023.

Design/Methods: The model for our QI involves four phases: Plan, Do, Study, Act (PDSA). The project takes place in the BCHS newborn nursery and labor and delivery (L&D) departments. The patient population is IDM, SGA, LGA, and late PT infants. Training sessions for staff about the use of dextrose gel were held starting in May 2021. A revised protocol (Figure 1) was initiated to introduce dextrose gel and it was stocked in the Pyxis for use in November 2021. A process map form was created to measure adherence to the revised protocol in July 2022 (Figure 2). In November 2022, newborns started to be weighed in the delivery room to identify SGA and LGA infants and improve adherence to the protocol from L&D.

Results: There has been a decrease in NICU admissions for NH from 100% to 50% in the most recent PDSA cycle (Figure 3).

Conclusion(s): Since the introduction of dextrose gel in our institution, there has been a decrease in NICU admissions for NH. The goals of the next PDSA cycle are to identify additional barriers leading to a delay in protocol adherence and to perform a chart review to determine continued efficacy of the intervention.