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  • Quality Improvement Article
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Decreasing early hypoglycemia frequency in at-risk newborns after implementing a new hypoglycemia screening algorithm

Journal of Perinatology volume 41, pages 2840–2846 (2021)Cite this article

Subjects

Abstract

Background

Neonatal hypoglycemia may affect long-term neurodevelopment.

Methods

Quality improvement (QI) initiative for Mother-Baby-Unit (MBU) admissions (birthweight ≥ 2100 g; ≥35 weeks’ gestation) over two epochs from 2016–2019 to reduce the frequency of early (≤3 h) neonatal hypoglycemia in small and large newborns.

Intervention

New algorithm using Olsen’s growth curves, hypoglycemia thresholds of <2.22 mmol/L [40 mg/dL] (0–3 h) and <2.61 mmol/L [47 mg/dL] (>3 to 24 h), feeding optimization and 24-hour glucose checks for small for gestational age and preterm newborns.

Results

Among 39,460 newborns, using subsets with identical screening criteria, early hypoglycemia decreased significantly after QI implementation among large for gestational age newborns with birthweight >3850 g (66%) and small for gestational age newborns with birthweight <2500 g (70%). Among all MBU admissions, the adjusted odds of any hypoglycemia in 24 h decreased (P < 0.001).

Conclusions

Feeding optimization may decrease early hypoglycemia frequency in large and small newborns.

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Fig. 1: Flow diagram of newborn groups.
Fig. 2: Percent neonates with any hypoglycemia during the first 3 h postnatal, p control charts.

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Acknowledgements

We acknowledge the hard work of our MBU staff. We thank Kakkilaya V for help with initial poster control charts and Muraleedharan P for help constructing figures and tables. We thank Jaleel M for his contribution in deciding glucose cutoffs and for manuscript review. We thank Savani RC for reviewing the final manuscript. We thank Gilbert J and Stehel EK for data on breastfeeding in the MBU. Preliminary results were presented as a poster: MS, JS, KJ: “Implementing an Improved Neonatal Hypoglycemia Algorithm” at the Pediatric Academic Societies Meeting, April 2019. An abstract by the current authors was presented as a platform presentation by MS: “Decreasing Early Hypoglycemia Frequency in At-Risk Newborns by Implementing a New Hypoglycemia Screening Algorithm” at the Pediatric Academic Societies Meeting, May 2021.

Author information

Authors and Affiliations

  1. University of Texas Southwestern Medical Center, Dallas, TX, USA

    Muraleedharan Sivarajan, Joseph H. Schneider, Kathryn A. Johnson, David B. Nelson, Patti J. Burchfield & Luc P. Brion

  2. University of California, San Diego, San Diego, CA, USA

    Kathryn A. Johnson

  3. Emory University School of Medicine, Atlanta, GA, USA

    Shasha Bai

  4. University of Arkansas for Medical Sciences, Arkansas Children’s Hospital, Little Rock, AR, USA

    Nahed O. ElHassan

  5. Penn State Children’s Hospital, Hershey, PA, USA

    Jeffrey R. Kaiser

  6. Parkland Hospital and Health System, Dallas, TX, USA

    David B. Nelson & Larry S. Brown

Authors
  1. Muraleedharan Sivarajan
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Contributions

All authors reviewed, edited and approved the manuscript as written. MS conceptualized the project, interpreted data and wrote the first draft of the manuscript. MS and KAJ took part in project planning, literature and manuscript review, meetings, logistics, analysis and implementation. KAJ developed the consensus algorithm, provided staff education and supervised implementation. JHS participated in planning, data analysis and interpretation. LSB gave statistical input. PJB compiled NICU data. DBN contributed maternal data. JRK, LPB, SB and NOE participated in the analysis of glucose cutoffs from the Arkansas cohort. LPB participated in building the algorithm and selection of growth curves; he conducted statistical analyses and built the statistical process control charts.

Corresponding author

Correspondence to Muraleedharan Sivarajan.

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Sivarajan, M., Schneider, J.H., Johnson, K.A. et al. Decreasing early hypoglycemia frequency in at-risk newborns after implementing a new hypoglycemia screening algorithm. J Perinatol 41, 2840–2846 (2021). https://doi.org/10.1038/s41372-021-01263-8

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