Audit of a clinical guideline for neonatal hypoglycaemia screening

Authors

  • Samantha L Sundercombe,

    1. Sydney Medical School, University of Sydney, Sydney, Australia
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  • Camille H Raynes-Greenow,

    1. Sydney School of Public Health, University of Sydney, Sydney, Australia
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  • Angela E Carberry,

    1. Sydney School of Public Health, University of Sydney, Sydney, Australia
    2. Department of Neonatal Medicine, Royal Prince Alfred Hospital, Sydney, Australia
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  • Robin M Turner,

    1. Sydney School of Public Health, University of Sydney, Sydney, Australia
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  • Heather E Jeffery

    Corresponding author
    1. Sydney Medical School, University of Sydney, Sydney, Australia
    2. Sydney School of Public Health, University of Sydney, Sydney, Australia
    3. Department of Neonatal Medicine, Royal Prince Alfred Hospital, Sydney, Australia
    • Correspondence: Professor Heather E Jeffery, International Maternal and Child Health, Sydney School of Public Health, Edward Ford Building (A27), The University of Sydney, NSW 2006 and Royal Prince Alfred Hospital, Newborn Care, Missenden Road Sydney, Australia. Fax: +61 2 9550 4375; email: heather.jeffery@sydney.edu.au

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  • Conflicts of interest: The authors have no personal or financial relationships to disclose relevant to this article.

Abstract

Aim

This study aims to evaluate adherence to a clinical guideline for screening and prevention of neonatal hypoglycaemia on the post-natal wards.

Methods

Retrospective chart review of 581 healthy term neonates born at a tertiary maternity hospital. Indications for hypoglycaemia screening included small for gestational age (SGA), infants of diabetic mothers (IDM; gestational, Type 1 or 2), symptomatic hypoglycaemia, macrosomia and wasted (undernourished) appearance. Outcomes were protocol entry and adherence with hypoglycaemia prevention strategies including early and frequent feeding and timely blood glucose measurement.

Results

Of 115 neonates screened for hypoglycaemia, 67 were IDM, 19 were SGA (including two both IDM and SGA), and two were macrosomic. One IDM and one SGA were not screened. Twenty-two neonates were screened for a reason not identifiable from the medical record, and 13 neonates were SGA by a definition different to the guideline definition, including five who were also IDM. Guideline adherence was variable. Few neonates (41 of 106, 39%) were fed in the first post-natal hour, and blood glucose measurement occurred later than recommended for 41 of 106 (39%) of neonates.

Conclusions

Most IDM and SGA neonates were screened. While guideline adherence overall was comparable with other studies, neonates were fed late. We recommend staff education about benefits of early (within the first hour) frequent breastfeeding for neonates at risk.

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