Abstract
Purpose: This quality improvement project was aimed to decrease admissions of term neonates to the NICU for treatment of hypoglycemia. A secondary aim was to identify the cost per dose of glucose gel.|Background: Hypoglycemia affects up to one fifth of term neonates during their first 48 hours of life. In many hospitals this requires the neonate to be transferred to a neonatal intensive care unit (NICU) for treatment with intravenous (IV) dextrose, which can have negative sequelae and increases healthcare costs. Administration of buccal glucose gel allows infants to stay with their mothers on the post-partum unit while their blood glucose levels normalize.|Sample/Setting: This QI project took place on the post-partum units at Methodist Women’s Hospital in Omaha, NE. Sixty-one neonates 36 weeks and greater within the first 48 hours of life with a blood sugar less than 40 mg/dL and without comorbidities received glucose gel post-implementation.|Methods: The Iowa Model of Evidence-Based Practice was utilized for the adoption of this practice change. Neonates with a blood sugar less than 40 mg/dL were given up to two doses of 0.5 ml/kg of 40% buccal glucose gel followed by at least 10 minutes of adequate breastfeeding or a minimum volume of 15 ml of breast milk or formula. The total number of admissions for hypoglycemia was compared to the total number of hypoglycemic infants meeting criteria for glucose gel for six months prior to and six months following implementation of glucose gel.|Results: In the six months prior to implementation of glucose gel, 14 patients transferred to the NICU for hypoglycemia out of a total of 51 patients with blood sugars less than 40 mg/dL. The six months following the implementation of glucose gel 13 infants with hypoglycemia were transferred to the NICU out of the 61 who were treated with glucose gel for a blood sugar less than 40 mg/dL. This resulted in a 6.1% decrease in admissions to the NICU for hypoglycemia, which was not statistically significant. The cost per dose of glucose gel was $3.|Conclusion: Glucose gel can be an effective intervention to decrease NICU admissions for transient hypoglycemia in some neonates. We recommended using it in addition to a feeding of breast milk or formula as a first line intervention for treating asymptomatic neonatal hypoglycemia in term neonates.