Implementation of a hypoglycemia bundle improved skin-to-skin contact and early feeding rates for mothers and newborns, and decreased the number of infants at risk for hypoglycemia admitted to intensive care, according to data presented at the national conference of the National Association of Pediatric Nurse Practitioners (NAPNAP).
Sherry LeBlanc, NNP-BC, RN, MSN, Neonatal Nurse Practitioner, from the University or North Carolina, Chapel Hill, and colleagues created a hypoglycemia bundle that placed greater emphasis on early feeding and universal skin-to-skin care for infants at risk for hypoglycemia, with the aim to decrease intensive care admission for asymptomatic hypoglycemia. They designed a quality improvement project which utilized retrospective chart review, comparing two 4 month epochs; April-July 2014 as the designated control group and March-2015 as the implementation group.
“Hypoglycemia is a common problem often requiring intensive care, resulting in mother infant separation, which can lead to decreased breastfeeding with associated long term health consequences,” the authors said. “Simple measures such as early breastfeeding and skin to skin care are proven to help maintain or raise blood glucose levels.”
Subjects included patients born at UNC Hospital with a risk factor of hypoglycemia. Patients were excluded for symptomatic hypoglycemia, or if they required intensive care admission for other problems, congenital anomalies, or palliative care. A total of 243 charts met criteria, with 208 in the control group and 215 in the implementation group.
Skin-to-skin care and early breastfeeding improved up to 70% and 65% in the implementation group compared with 45% and 40% in the control group, respectively. Infants admitted to intensive care that did not receive IV dextrose decreased from 10 infants in the control group to 1 infant in the implementation group. Intensive care average admission rates for infants at risk for hypoglycemia decreased from 13% in the control group to 5% in the implementation group. No negative outcomes were recorded.
- LeBlanc S, Haushalter J, Seashore C, Sutton AG. Reducing Intensive Care Admissions for Asymptomatic Hypoglycemia. Abstract TH-12. Presented at the national conference of the National Association of Pediatric Nurse Practitioners; March 16-19, 2017; Denver.