772 Audit of the management of term babies at risk of hypoglycaemia

Abstract

<h3>Background</h3> BAPM introduced new guideline in April 2017 on identification and management of neonatal hypoglycaemia in the full term infant. This was adopted in our Level 2 Neonatal unit in October 2018. We wanted to assess if we were adhering to it. Hypoglycaemia is the most common manifestation of failure of metabolic adaptation in the newborn period. It can have devastating consequences if we do not manage appropriately. It is associated with increased rates of executive and visual motor dysfunction <i>(Christopher etal)</i>. It is one of the reasons for claims in NHS (<i>Howden etal)</i>. We need to be aware of the various causes of hypoglycaemia in term babies and have a low threshold to screen for sepsis. We wanted to ensure that we are providing Intensive breast feeding support and using 40% dextrose gel (200mg/kg) as the initial management. Guideline suggest two different values for target blood glucose in hyperinsulinism i.e. 3mmol/L in first 48hrs and 3.5mmol/L after that. <h3>Objectives</h3> To look into number of term babies admitted to the neonatal unit with hypoglycaemia To understand the causes of hypoglycaemia in term babies in our unit To see if the management was as per the BAPM guideline <h3>Methods</h3> Duration: 6 months (Nov 2018 to Apr 2019) Study population: Term Babies at risk of Hypoglycaemia Of all the babies admitted, 17 met the inclusion criteria <h3>Results</h3> 2/3rd of the babies were infant of diabetic mother 88% of the babies had feeding regime documented 100% of the babies had temperature checked 100% of the babies had pre-second feed blood glucose and temperature checked 100%of the mothers had support with feeding &amp; hand expression 100% of babies receive 10–15ml/kg/feed 3hrly over first 24hrs 88% of the time the blood glucose was measured by gas machine Only 18% of the babies needed IV fluids (n=3) Only 12% (n=2) of the babies had blood glucose &lt;1 as pre-second feed blood glucose <h3>Important findings</h3> Only 53% of the babies had feeding commenced within one hour after birth 50% of the babies did not receive 200mg/kg of 40% Dextrose gel 25% of the babies in blood glucose 1–1.9 mmol/L group and 50% in severe hypoglycaemia group (blood glucose &lt;1 mmol/L) were not screened for hypoglycaemia Sepsis was not considered in 37% of the cases Documentation (feeding regime, indication for blood glucose monitoring) needs improvement Hyperinsulinism was considered in 100% of the cases 100% of the severe hypoglycaemia group had blood glucose checked within 30min <h3>Conclusions</h3> Overall there was good adherence to the guideline Areas of improvement were identified in particular relating to starting feeds within an hour after birth for high risk cases and the use of 40% dextrose gel. These issues are dealt in the postnatal ward. So, we presented the data to the Maternity governance team for the education of midwives. Hypoglycaemia screening and sepsis was not considered in few cases so we have put the guideline as the lesson of the week with reminders at the safety huddle. We are planning to re-audit in 6–12 months