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  • Quality Improvement Article
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Fewer glucose checks and decreased supplementation using dextrose gel for asymptomatic neonatal hypoglycemia

Journal of Perinatology volume 43, pages 532–537 (2023)Cite this article

Subjects

Abstract

Objective

Evaluate the impact of a neonatal hypoglycemia (NH) clinical pathway implementing buccal dextrose gel in late preterm and term infants.

Study design

Quality improvement study at a children’s hospital associated birth center. Number of blood glucose checks, use of supplemental milk, and need for IV glucose were followed for 26-months after implementation of dextrose gel and compared to previous 16-month period.

Results

After QI implementation, 2703 infants were screened for hypoglycemia. Of these, 874 (32%) received at least one dose of dextrose gel. Special cause shifts with reductions in mean number of blood glucose checks per infant (pre 6.6 vs. post 5.6), use of supplemental milk (pre 42% vs. post 30%), and need for IV glucose (pre 4.8% vs. post 3.5%) were found.

Conclusion

Incorporating dextrose gel into a clinical pathway for NH was associated with a sustained reduction in number of interventions, use of supplemental milk and need for IV glucose.

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Fig. 1: Mean number of blood glucose checks in first 48 h after birth in infants ≥35 weeks screened for hypoglycemia.
Fig. 2: Percentage of infants ≥35 weeks screened for hypoglycemia who required IV dextrose for hypoglycemia.
Fig. 3: Changes in supplementation among infants screened for hypoglycemia.

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Data availability

A deidentified dataset is available by written request to the corresponding author.

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Acknowledgements

The authors thank the nurses, pharmacists, and physicians in our newborn nurseries who were instrumental in making this practice change successful. We also thank the Stanford Children’s Health Value Improvement Program which greatly facilitated data collection and analysis efforts and development of patient education materials.

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Authors and Affiliations

  1. Department of Pediatrics, Stanford School of Medicine, Stanford, CA, USA

    Christine Walravens, Arun Gupta, Ronald S. Cohen & Adam Frymoyer

  2. Palo Alto Medical Foundation, Palo Alto, CA, USA

    Juliann L. Kim

Authors
  1. Christine Walravens
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  2. Arun Gupta
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  3. Ronald S. Cohen
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  4. Juliann L. Kim
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  5. Adam Frymoyer
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Contributions

CW: conceptualization, visualization, securing institutional support for data curation, writing—original draft. AG, RSC and JLK: conceptualization, methodology, writing—review and editing. AF: conceptualization, methodology, formal analysis, interpretation and visualization of data, writing—review and editing.

Corresponding author

Correspondence to Christine Walravens.

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Competing interests

AF is a scientific advisor and holds a financial interest in Halo Biosciences which is unrelated to the current work. The other authors have no conflicts of interest relevant to this article to disclose.

Ethical approval

This project was reviewed by the university’s Institutional Review Board and determined to be a local QI project that did not meet the definition of human subjects research.

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Walravens, C., Gupta, A., Cohen, R.S. et al. Fewer glucose checks and decreased supplementation using dextrose gel for asymptomatic neonatal hypoglycemia. J Perinatol 43, 532–537 (2023). https://doi.org/10.1038/s41372-023-01638-z

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  • DOI: https://doi.org/10.1038/s41372-023-01638-z

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