Prevention of Newborn Hypoglycemia Algorithm

Abstract

Background: Newborns at a higher risk for developing hypoglycemia are defined as newborns born small or large for gestational age, late-preterm (34-36 and 6/7 weeks gestation), those born to mothers with diabetes and any newborn exhibiting clinical signs of hypoglycemia. Identified newborns are monitored and often fed formula to stabilize their blood glucose level. Many mothers plan to breastfeed exclusively, but when formula is fed to their newborns exclusive and long-term breastfeeding is decreased. Applying the Baby-Friendly Hospital Initiative interventions like skin to skin care, frequent breastfeeding and feeding hand expressed colostrum to the at-risk newborns may prevent hypoglycemia, stabilize the glucose levels, lessen formula supplementation, and increase exclusive breastfeeding rate. The Prevention of Newborn Hypoglycemia Algorithm supports the AAP Screening and Management of Postnatal Glucose Homeostasis Algorithm, the Academy of Breastfeeding Medicine and the Baby Friendly guidelines to prevent and reduce newborn hypoglycemia and related formula use, increase breastfeeding rates and thereby improve delivery of care. Local Problem: The community hospital was initiating the process of becoming a Baby Friendly Hospital and recognized that their use of formula to manage hypoglycemia in at-risk newborns was very high and sought to decrease its use and consequently increase breastfeeding rates. The hospital currently uses an algorithm based on the AAP Hypoglycemia Algorithm that does not incorporate some of the Baby Friendly interventions. There are inconsistencies of the management in the care of the at-risk newborns. Interventions: The purpose of this quality improvement project was to implement and evaluate the effectiveness of the Prevention of Hypoglycemia Algorithm for the at-risk newborns in a community hospital. The implementation included instruction and guidance of the nursing staff in the components and the use of the algorithm. The use of the algorithm was assessed in the overall and the at-risk number of newborns that were ever and exclusively breastfed during the intervention period. At the end of the implementation, the nurses evaluated the usability of the algorithm with the Algorithm Usability Questionnaire. Results: Overall the ever-breastfeeding rate increased slightly but the exclusive breastfeeding rate dropped. During the intervention, all of the at-risk newborns were managed with parts of the algorithm and 100% breastfed some of the feedings. The exclusively breastfeeding rate was 67% in the first month and 20% the second month. There was a 70% staff approval for ease of use of the algorithm. Conclusions: All at-risk newborns breastfed for some of the feedings in the hospital during the intervention. There was an increase in the awareness of at-risk newborn hypoglycemia prevention and the use of the algorithm recommendations for all newborns. The algorithm served as a prompt to apply the Baby Friendly interventions while preventing hypoglycemia, managing the blood glucose levels, lessen formula supplementation and preserving the newborns breastfeeding abilities. The Algorithm remained posted on the nursing unit to assist this practice change to manage the at-risk newborns and help the hospital become a Baby-Friendly designated facility.