Background: Recent studies suggest that glucose gel is effective for treating neonatal hypoglycemia, thus it may reduce neonatal intensive care unit (NICU) admissions. The purpose of this study is to compare NICU admissions and care for hypoglycemia pre- and post-implementation of a glucose gel protocol for the management of neonatal hypoglycemia.
Methods: This is a retrospective cohort study which analyzed 224 (139 pre-intervention, 85 post-intervention) neonates at risk for hypoglycemia born between January 2017 and September 2017 at a Midwest, high-risk delivery center and admitted to the newborn nursery. Subjects included had the following risk factors: infants of diabetic mothers, late preterm, small-for-gestational age, and large-for-gestational age. Pre-intervention data was gathered between January and March 2017. Pre-intervention, hypoglycemic neonates (blood glucose ≤ 40 mg/dL at < 4 hours of life and ≤ 45 mg/dL at 4-24 hours of life) were breast and/or bottle fed. The hypoglycemia protocol was initiated between March and July 2017. Post-intervention data was gathered between July and September 2017. Post-intervention hypoglycemic neonates were treated with a dose of 40% dextrose proportional to their birth weight (1-2.5 ml/kg) and breast and/or bottle fed. Transfers were indicated for persistent hypoglycemia. The primary outcome was percent of NICU admissions for neonatal hypoglycemia management pre- and post-intervention. Predictors included risk factors for hypoglycemia including late preterm, infant of diabetic mother, and small- or large-for-gestational-age.
Results: A total of 224 infants were screened for hypoglycemia (139 pre- and 85 post-intervention). The study sample demographics were 2.2% Hispanic, 49.1% Black, and 20.1% White with 25.9% unknown. 50.4% of infants were female. The mean birthweight was 2923.40 grams (±700.16) and the mean gestational age was 37.98 weeks (±1.55). 23.2% of subjects’ mothers planned to bottle feed, 66.5% planned to breastfeed, and 10.3% planned to do both. There was no statistically significant difference in these characteristics in the pre- versus post-intervention period.The percent of NICU admissions dropped from 20.5% to 18.5% in the post-intervention period (p-value = 0.751). 12.9% vs. 11.8% of neonates required IV glucose in the pre- and post-intervention group respectively (p-value = 0.795). 4.3% vs. 7.1% of neonates required orogastric or nasogastric feeds in the pre- and post-intervention group respectively (p-value = 0.376). 13.7% vs. 12.9% of neonates required intensive care in the pre- and post-intervention group respectively (p-value = 0.877). After adjusting for risk factors, intervention status remained non-significant as a predictor of NICU admissions. Though non-significant, 16.7% vs. 0% of large-for-gestational age neonates received intensive care in the pre- and post-intervention group respectively (p-value = 0.5292). Similarly, 20.0% vs. 11.1% of late preterm infants required intensive care in the pre- and post-intervention group respectively (p-value = 0.4583).
Conclusions: Glucose gel did not reduce the percent of NICU admissions or type of intensive care received. Although not statistically significant, the trends seen in large-for-gestational age and late preterm neonates pre- and post-intervention appear promising and will be further studied.