Variations in New Zealand and Australian guidelines for the management of neonatal hypoglycaemia: A secondary analysis from the hypoglycaemia Prevention with Oral Dextrose gel Trial (hPOD).

Abstract

We observed wide variation in the management of babies at risk of hypoglycaemia who participated in the hPOD (hypoglycaemia Prevention with Oral Dextrose gel) multicentre trial of prophylactic dextrose gel. The aim of this study was to identify whether this may be due to variations in the clinical guidelines used by participating hospitals. Guidelines for management of neonatal hypoglycaemia used by participating hospitals were reviewed. Recommendations regarding definition, risk factors, monitoring and treatment were compared between countries, hospital type (tertiary or secondary) and neonatal intensive care unit size (≤12 cots and >12 cots). The 18 hospitals used 20 guidelines. The recommended diagnostic threshold for hypoglycaemia ranged from <2.0 mmol/L to <2.6 mmol/L, and glucose oxidase method of testing was recommended in seven (47%) of 15 guidelines. There was broad agreement about which infants should be monitored. Oral dextrose was the recommended first line of treatment in 17 of 20 guidelines, but the glucose threshold at which this should be used varied (≤2.6 mmol/L in New Zealand, 1.5-2.6 mmol/L in Australia). Re-checking blood glucose concentrations after oral dextrose was recommended at 30 min in most (10/11, 91%) New Zealand guidelines but at 60 min in most (4/6, 67%) Australian guidelines. There was greatest variation in recommended thresholds for referral to paediatric services or neonatal intensive care unit, and administration of intravenous dextrose. There were no significant differences between guidelines used by tertiary and secondary hospitals, or large and small hospitals. There is wide variation in guideline recommendations for the management of neonatal hypoglycaemia across New Zealand and Australian neonatal units.