Use of Dextrose Gel Reverses Neonatal Hypoglycemia and Decreases Admissions to the NICU

Abstract

<h2>Poster Presentation</h2><h3>Objective</h3> To reduce newborn admission to the neonatal intensive care unit (NICU) for the diagnosis of neonatal hypoglycemia by using 40% dextrose gel rather than intravenous (IV) dextrose. <h3>Design</h3> A retrospective chart review of more than 700 charts from 2013 was performed prior to implementation, and approximately 60 charts per month were reviewed postimplementation. <h3>Sample</h3> The sample included infants at risk for neonatal hypoglycemia born at a tertiary teaching institution. Inclusion criteria were 35 0/7‐ to 42 0/7‐weeks gestation with one of the following conditions: small for gestational age, large for gestational age, an infant of a diabetic mother, late preterm infant, or an Apgar score of <7 at 5 minutes. <h3>Methods</h3> A protocol was developed for the treatment of infants at risk for hypoglycemia. Newborns were fed within the first hour of life. A bedside blood glucose (BG) level was obtained 30 minutes after the feeding was completed. If the BG was < 35, the registered nurse (RN) administered dextrose gel per syringe to the buccal cavity of the infant and placed the infant with the mother to feed. A BG level was then repeated after one hour. If the BG level was < 35 a second dose of the gel was administered. If hypoglycemia was not reversed following the second dose, the physician was contacted for further orders. <h3>Implementation Strategies</h3> After review of a randomized controlled study our multidisciplinary newborn advisory committee (NAC) added glucose gel to the neonatal hypoglycemia protocol. The NAC collaborated with the pharmacy to establish weight base dosing of dextrose gel. Mandatory educational sessions were provided to all RNs that focused on the rationale for change, use of the new algorithm, and the technique to administer the gel. Once all was in place a go live date was set of May 15. Data collection began in June 2014. <h3>Results</h3> Following the implementation of the protocol, admission to the NICU for the diagnosis of neonatal hypoglycemia decreased from a mean of 11% to 2%. <h3>Conclusion/Implications for Nursing Practice</h3> The utilization of dextrose gel along with oral feeding resulted in a decrease in the incidence of neonatal hypoglycemia with a corresponding decrease in the admission rates to the NICU for the primary diagnosis of neonatal hypoglycemia. This inexpensive, noninvasive intervention can be adopted by other institutions to decrease NICU admissions for the primary diagnosis of neonatal hypoglycemia.