Neonatal Hypoglycemia and the Effects of Dextrose Gel

Abstract

In 2011, the American Academy of Pediatrics published guidelines for the management of neonatal hypoglycemia. These were guidelines only, because no absolute blood glucose level has been associated with adverse neonatal outcomes. The implementation of these guidelines caused an increased number of admissions to the NICU for neonates with hypoglycemia in the institution. NICU admissions are costly, stressful to the newborn, disrupt parent–newborn bonding, and can negatively impact exclusive breastfeeding rates. In the Sugar Babies Study, the use of dextrose gel was reviewed for treatment of neonatal hypoglycemia in neonates 35 weeks or older gestational age and 48 hours or less of life. The study found a decrease in NICU admission rates, which provided more time for parent–infant bonding, and an increase in 2-week postbirth breastfeeding rates. A new hypoglycemia algorithm would be developed, including the administration of dextrose gel. Dextrose gel would be given to neonates with blood glucose levels less than 45 mg/dl, followed by a feeding of either breast milk or formula. Implementation was preceded by a vigorous educational intervention targeted to reach 85% of the nursing staff. Nurses were given a folder of materials, including a review of how to perform a heel stick; the new hypoglycemia algorithm; the procedure for dextrose administration; and the nursing policy and procedure for hypoglycemia. A demonstration was also provided for the disbursement and administration of dextrose gel. A physician’s order for dextrose gel was added to the Computerized Physician Order Entry (CPOE) system. The dextrose gel was also added to the medication delivery system. Implementation went smoothly, and an immediate effect was noted. Although we did not see a 73% decrease in NICU admissions, as noted in some of the literature, a significant decrease in NICU admissions occurred, with a concomitant improvement of exclusive breastfeeding rates. Dextrose gel administration is a viable alternative to feeding alone for neonates with hypoglycemia, with the results of a reduction in NICU admissions and improvement in exclusive breastfeeding rates. Perinatal nurses can have a significant impact on the NICU admission rates of neonates with hypoglycemia through the administration of dextrose gel in addition to breast milk or formula feeding.