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  • Quality Improvement Article
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Evaluating the effects of a neonatal hypoglycemia bundle on NICU admission and exclusive breastfeeding

Journal of Perinatology volume 40, pages 344–351 (2020)Cite this article

Subjects

Abstract

Objective

Early feeding, skin-to-skin contact, and dextrose gel have been independently shown to promote breastfeeding and decrease NICU admission for neonatal hypoglycemia. We combined these interventions to decrease NICU admissions for asymptomatic hypoglycemia and increase exclusive breastfeeding rates.

Project design

The IHI Model for Improvement was used to design a bundle including feeding within 1 h of birth, 1 h of uninterrupted skin-to-skin within 2 h of birth, and administration of buccal 40% dextrose gel for hypoglycemic infants.

Results

Utilization of dextrose gel was 94% following implementation. There were no trends in exclusive breastfeeding at discharge or NICU admissions for asymptomatic hypoglycemia. Post hoc multivariate analysis identified cesarean delivery as an independent risk factor for compliance failure and failure of exclusive breastfeeding but not for NICU admission.

Conclusions

Despite high compliance with dextrose gel utilization, there was no change in exclusive breastfeeding at discharge or NICU admission rates for asymptomatic hypoglycemia.

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Acknowledgements

The authors would like to acknowledge the team of nursing leaders who assisted with bundle implementation and data abstraction. We would like to thank Lawanda Clark, RNC, for her leadership and assistance with this project. We also acknowledge Ericka Anderson, RN, Gloria Rapkin, RN, and Nyaunuwi Brown, RN for their assistance with data collection.

Author information

Authors and Affiliations

  1. Brooke Army Medical Center, Fort Sam Houston, TX, USA

    Adharsh P. Ponnapakkam, M. Cristina Gallup, Andrew J. Delle Donne, Jacqueline K. Wade, Elizabeth A. Koslow & Nicholas R. Carr

  2. Central Ohio Newborn Medicine, Columbus, OH, USA

    Christina N. Stine

  3. Pediatrix Medical Group of San Antonio, San Antonio, TX, USA

    Kaashif A. Ahmad, Charmaine M. Kathen & Blanca C. Molina

  4. Baylor College of Medicine, San Antonio, TX, USA

    Kaashif A. Ahmad & Blanca C. Molina

Authors
  1. Adharsh P. Ponnapakkam
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  2. Christina N. Stine
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  3. Kaashif A. Ahmad
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  4. M. Cristina Gallup
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  5. Andrew J. Delle Donne
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  6. Charmaine M. Kathen
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  7. Jacqueline K. Wade
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  8. Blanca C. Molina
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  9. Elizabeth A. Koslow
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  10. Nicholas R. Carr
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Corresponding author

Correspondence to Adharsh P. Ponnapakkam.

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Conflict of interest

The authors declare that they have no conflict of interest. The view(s) expressed herein are those of the author(s) and do not reflect the official policy or position of Brooke Army Medical Center, the U.S. Army Medical Department, the U.S. Army Office of the Surgeon General, the Department of the Air Force and Army, Department of Defense or the U.S. Government.

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Ponnapakkam, A.P., Stine, C.N., Ahmad, K.A. et al. Evaluating the effects of a neonatal hypoglycemia bundle on NICU admission and exclusive breastfeeding. J Perinatol 40, 344–351 (2020). https://doi.org/10.1038/s41372-019-0455-1

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  • DOI: https://doi.org/10.1038/s41372-019-0455-1

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