Presented To Department of Nursing March 5, 2008 Carol Burke, APN Evidenced Based Practice Neonatal Hypoglycemia

Teamwork pays off with hypoglycemia protocol!  admissions from 116 to 35 to NICU related to hypoglycemia in 1 month! Moms and babies stay together Better glucose control for babies  Identification of babies at risk  Assistance with feeding  Compliance to protocol from 19% to 85% Keep up the excellent work Recognizing quality patient care and nursing excellence, the ultimate benchmark patients can expect to receive

Evidenced Based Practice A problem-solving approach utilizing the current best evidence in making decisions about patient care. Evaluate and revise current nursing practice based on research and expert opinion and standards of practice.

Hey, you could have shared some glucose Glucose Stabilization

Continuous supply of maternal glucose via placenta

Mean glucose reading IDM can be a very low glucose reading

Glucose Stabilization after Birth Hours of age Reserves needed in immediate neonatal period when transfer of glucose is abruptly stopped Normal newborn Glucose at PWH is > 55mg/dL

Glucometer accuracy +10mg/dL % of the time, the glucometer overestimates blood glucose May be

Neonates “at risk” for hypoglycemia Too much insulin? IDM & LGA Too few reserves Too few reserves? Preterm SGA, IUGR Too much demand Too much demand? Resuscitation, Hypothermia Tachypnea Sepsis

Can we do anything to minimize the drop in glucose?

will minimize the decrease in blood sugar Keeping baby warm and early feeding will minimize the decrease in blood sugar Glucose fall is potentially decreased

Nursing practice priorities immediately after birth NRP stabilization Keep baby warm – skin to skin Feed baby within minutes Glucose is primary fuel for brain function For ALL babies

When to assess glucose? Hours of age Feed first A status check on glucose stability

Schedule for feeding and glucose measurement Risk factor30 min 1 hr3hr6hr9hr12hr IDM XXXXXXXX < 37 wks, SGA XXXXXXXX LGA XXXX Discontinue if last 3 readings >55mg/dL APGAR < 6 XX Discontinue if last 3 readings > 55mg/dL Symptomatic When symptoms present – follow #7 (Intervention Pathway) = feed BEFORE glucose check X = feed AFTER glucose check

If ANY glucometer reading is 55 or less the infant just bought a ticket to the

ANY Glucose check <40mg/dL Newborn on protocol NICU Formula Feed 10ml/Kg Significant Hypoglycemia

Glucose check 40-49mg/dL Newborn on protocol NICU Formula Feed 10ml/Kg Wait 30 minutes, then recheck glucose Second glucose reading Is < 55 mg/dL Second glucose reading After the feeding is > 55 Moderate Hypoglycemia

Glucose check mg/dL Newborn on protocol Wait 30 minutes, then recheck glucose Glucose > 55 3 rd reading NICU Breastfeed or Formula Feed 10ml/Kg Wait 30 minutes, then recheck glucose Second reading remains < 55 Third reading remains < 55

Hatched area indicates safe areas for puncture site. Warm site with soft cloth, moistened with warm water up to 100 , or use heel warmer for 3-5 minutes Cleanse site with alcohol prep. Wipe DRY with sterile gauze pad. Puncture skin, wipe off first drop of blood with sterile gauze use second drop of blood

Compliance with Hypoglycemia Protocol New Hypoglycemia Protocol implemented Privileged and Confidential Under the Illinois Medical Studies Act

Summary Moms and babies stay together Stabilized glucose control for babies  Identification of babies at risk  Assistance with feeding  Compliance to protocol from 19% to 85%  admissions to NICU Incidence of hypoglycemia congruent with expected volume