Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

The impact of the Baby Friendly Hospital Initiative on neonatal hypoglycemia

Journal of Perinatology volume 40, pages 1828–1833 (2020)Cite this article

Subjects

Abstract

Objective

To assess Neonatal Intensive Care Unit (NICU) admissions for hypoglycemia after the introduction of the Baby Friendly Hospital Initiative (BFHI), followed by implementation of American Academy of Pediatrics recommended hypoglycemia guidelines.

Study design

Retrospective review of NICU admissions for hypoglycemia. Eligible subjects were healthy infants >35 weeks gestation transferred to a NICU for hypoglycemia. Infants admitted with other pathologies were excluded. NICU admissions from 3 different 18-month epochs (1 = pre-BFHI; 2 = post-BFHI; 3 = post-BFHI+hypoglycemia guidelines) were compared.

Results

After implementation of BFHI there was a statistically significant increase in admissions for hypoglycemia (Epoch 2 = 1.23% vs Epoch 1 = 0.55%, p < 0.001). Followed by a decrease in admissions after the implementation of hypoglycemia guidelines (Epoch 2 = 1.23% vs Epoch 3 = 0.76%, p = 0.03).

Conclusion

NICU admissions for hypoglycemia increased with the BFHI. Hypoglycemia guidelines decreased NICU admissions, but not to the pre-BFHI baseline.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1

Similar content being viewed by others

References

  1. Zhou W, Yu J, Wu Y, Zhang H. Hypoglycemia incidence and risk factors assessment in hospitalized neonates. J Matern-Fetal Neonatal Med. 2015;28:422–5.

    CAS  PubMed  Google Scholar 

  2. Dassios T, Greenough A, Leontiadi S, Hickey A, Kametas NA. Admissions for hypoglycaemia after 35 weeks of gestation: perinatal predictors of cost of stay. J Matern-Fetal Neonatal Med. 2019;32:448–54.

    PubMed  Google Scholar 

  3. McKinlay CJD, Alsweiler JM, Ansell JM, Anstice NS, Chase JG, Gamble GD, et al. Neonatal Glycemia and Neurodevelopmental Outcomes at 2 Years. N Engl J Med. 2015;373:1507–18.

    CAS  PubMed  PubMed Central  Google Scholar 

  4. Glasgow MJ, Harding JE, Edlin R. Children with Hypoglycemia and Their Later Development (CHYLD) Study Team. Cost analysis of treating neonatal hypoglycemia with dextrose gel. J Pediatr. 2018;198:151–.e1.

    PubMed  PubMed Central  Google Scholar 

  5. Kozen K, Dassios T, Kametas N, Kapoor RR, Greenough A. Transient neonatal hyperinsulinaemic hypoglycaemia: perinatal predictors of length and cost of stay. Eur J Pediatr. 2018;177:1823–9.

    CAS  PubMed  Google Scholar 

  6. Shim M, Yang S, Messina CR, Mintzer JP. Discharge breastmilk feeding rates in asymptomatic term newborns admitted to the neonatal intensive care unit for maternal chorioamnionitis. J Matern-Fetal Neonatal Med. 2018;32:2688–93.

    PubMed  Google Scholar 

  7. Section on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics. 2012;129:e827–41.

    Google Scholar 

  8. WHO|Baby-friendly Hospital Initiative [Internet]. WHO. http://www.who.int/nutrition/topics/bfhi/en/. Accessed 4 Mar 2019.

  9. Munn AC, Newman SD, Mueller M, Phillips SM, Taylor SN. The impact in the United States of the Baby-Friendly Hospital Initiative on early infant health and breastfeeding outcomes. Breastfeed Med J Acad Breastfeed Med. 2016;11:222–30.

    Google Scholar 

  10. Harris DL, Gamble GD, Weston PJ, Harding JE. What happens to blood glucose concentrations after oral treatment for neonatal hypoglycemia? J Pediatr. 2017;190:136–41.

    CAS  PubMed  Google Scholar 

  11. Institute of Medicine (US) Committee on Standards for Developing Trustworthy Clinical Practice Guidelines. Clinical Practice Guidelines We Can Trust [Internet]. Graham R, Mancher M, Miller Wolman D, Greenfield S, Steinberg E, editors. Washington (DC): National Academies Press (US); 2011. http://www.ncbi.nlm.nih.gov/books/NBK209539/. Accessed 15 May 2020.

  12. Committee on Fetus and Newborn, Adamkin DH. Postnatal glucose homeostasis in late-preterm and term infants. Pediatrics. 2011;127:575–9.

    Google Scholar 

  13. Breastfeeding Expert Workgroup, Committee on Obstetric Practice. ACOG Committee Opinion No. 756: optimizing support for breastfeeding as part of obstetric practice. Obstet Gynecol. 2018;132:e187–96.

  14. Steinhorn RH. Breastfeeding, baby-friendly, and safety: getting the balance right. J Pediatr. 2020;218:7–8.

    PubMed  Google Scholar 

  15. Wyatt T, Shreffler KM, Ciciolla L. Neonatal intensive care unit admission and maternal postpartum depression. J Reprod Infant Psychol. 2019;37:267–76.

    PubMed  Google Scholar 

  16. Cordero L, Gabbe SG, Landon MB, Nankervis CA. Breastfeeding initiation in women with gestational diabetes mellitus. J Neonatal-Perinat Med. 2013;6:303–10.

    CAS  Google Scholar 

  17. Jankowski RF. Implementing national guidelines at local level. BMJ. 2001;322:1258–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  18. Sasson C, Forman J, Krass D, Macy M, Hegg AJ, McNally BF, et al. A qualitative study to understand barriers to implementation of national guidelines for prehospital termination of unsuccessful resuscitation efforts. Prehosp Emerg Care. 2010;14:250–8.

    PubMed  Google Scholar 

  19. Burns CM, Rutherford MA, Boardman JP, Cowan FM. Patterns of cerebral injury and neurodevelopmental outcomes after symptomatic neonatal hypoglycemia. Pediatrics. 2008;122:65–74.

    PubMed  Google Scholar 

  20. McKinlay CJD, Alsweiler JM, Anstice NS, Burakevych N, Chakraborty A, Chase JG, et al. Association of neonatal glycemia with neurodevelopmental outcomes at 4.5 years. JAMA Pediatr. 2017;171:972–83.

    PubMed  PubMed Central  Google Scholar 

  21. Shah R, Harding J, Brown J, McKinlay C. Neonatal glycaemia and neurodevelopmental outcomes: a systematic review and meta-analysis. Neonatology. 2019;115:116–26.

    CAS  PubMed  Google Scholar 

  22. Wickström R, Skiöld B, Petersson G, Stephansson O, Altman M. Moderate neonatal hypoglycemia and adverse neurological development at 2-6 years of age. Eur J Epidemiol. 2018;33:1011–20.

    PubMed  PubMed Central  Google Scholar 

  23. Scheid LM, Brown LS, Clark C, Rosenfeld CR. Data electronically extracted from the electronic health record require validation. J Perinatol. 2019;39:468–74.

    PubMed  Google Scholar 

  24. Harris DL, Weston PJ, Signal M, Chase JG, Harding JE. Dextrose gel for neonatal hypoglycaemia (the Sugar Babies Study): a randomised, double-blind, placebo-controlled trial. Lancet. 2013;382:2077–83.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatrics, Division of Neonatology, University of New Mexico School of Medicine, Albuquerque, NM, USA

    Marina S. Oren, Whittney D. Barkhuff, Beatrice M. Stefanescu & Tara L. DuPont

  2. Department of Pediatrics, Division of Neonatology, University of Vermont, Burlington, VT, USA

    Whittney D. Barkhuff

  3. Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA

    Andrei Stefanescu

  4. Department of Pediatrics, Division of Neonatology, Indiana University School of Medicine, Indianapolis, IN, USA

    Beatrice M. Stefanescu

  5. Department of Pediatrics, Division of Neonatology University of Utah Health Science Center, Salt Lake City, UT, USA

    Tara L. DuPont

Authors
  1. Marina S. Oren
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Whittney D. Barkhuff
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Andrei Stefanescu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Beatrice M. Stefanescu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tara L. DuPont
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

M.S.O., W.D.B., A.S., B.M.S., and T.L.D. all contributed substantially to the conception, design of the work; data acquisition, analysis, and interpretation of data for the work. All authors were involved in drafting the work or revising it critically for important intellectual content and gave final approval of the version to be published; they reached agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Tara L. DuPont.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Oren, M.S., Barkhuff, W.D., Stefanescu, A. et al. The impact of the Baby Friendly Hospital Initiative on neonatal hypoglycemia. J Perinatol 40, 1828–1833 (2020). https://doi.org/10.1038/s41372-020-00822-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41372-020-00822-9

This article is cited by

Search

Advanced search

Quick links