AMAZON=OUR LUNGS

#####################################

Hypoglycaemia is important because it is a common, readily diagnosed and readily treated problem. If untreated, it may cause permanent brain damage.

#######################

Evaluating the effects of a neonatal hypoglycemia bundle on NICU admission and exclusive breastfeeding

Journal of Perinatology QI Aug2019

Early feeding, skin-to-skin contact, and dextrose gel have been independently shown to promote breastfeeding and decrease NICU admission for neonatal hypoglycemia. We combined these interventions to decrease NICU admissions for asymptomatic hypoglycemia and increase exclusive breastfeeding rates.

Conclusions

Despite high compliance with dextrose gel utilization, there was no change in exclusive breastfeeding at discharge or NICU admission rates for asymptomatic hypoglycemia.

#######################

A Quality-Improvement Initiative to Reduce NICU Transfers for Neonates at Risk for Hypoglycemia

, ediatrics March 2018,

CONCLUSIONS: The implementation of a quality-improvement intervention promoting SSC and early feeding in at-risk infants was associated with a decreased rate of transfer to the NICU for hypoglycemia.

####################

PE SEVERITY OF HYPOGLYCEMIA-CLUES

	MILD - MODERATE	SEVERE
Neurological	Irritability Jitteriness Tremors Hypotonia Lethargy Temperature instability High-pitched cry	Eye-roll Seizures Altered conscious state
Respiratory	Tachypnoea	Hypoventilation Apnoea Cyanosis
Cardiovascular	Tachycardia Diaphoresis	Pallor
Gastrointestinal	Poor-feeding Vomiting

#########################

OBJECTIVES

Risk factors and causes of neonatal hypoglycaemia
Clinical manifestations of neonatal hypoglycaemia
Investigations of neonatal hypoglycaemia
Nursing management to prevent and manage of neonatal hypoglycaemia
Medical management of neonatal hypoglycaemia

###########################################

J. M. Yamamoto, M. (2017). Large-for-gestational-age (LGA) neonate predicts a 2.5-fold increased odds of neonatal hypoglycaemia in women with type 1 diabetes. Diabetes Metab Res Rev; 33, 1-7.

This study suggests that LGA neonates of women with type 1 diabetes should prompt increased surveillance for neonatal hypoglycaemia and that the presence of optimum maternal glycaemic control should not reduce this surveillance.

#####################################

D. Ogunyemi, (2017). Obstetrical correlates and perinatal consequences of neonatal hypoglycemia in term infants. J Matern Fetal Neonatal Med, 2017

Macrosomia, caesarean section, decreasing gestational age, treatment for chorioamnionitis and SGA seem to be the most consistent independent risk factors of neonatal hypoglycaemia in this obstetric population.  Macrosomic infants have higher concentrations of free insulin, which correlates with birth weight and neonatal hypoglycaemia  Small for gestational age was the most significant independent factor in the prenatal factors analysis with a 6.8-fold increased risk for neonatal hypoglycaemia.

#############################################

Hawdon, J. M. (2016). Postnatal metabolic adaptation and neonatal hypoglycaemia. Paediatrics and Child Health

Low Blood glucose levels are commonly found in healthy, appropriate weight for gestation, however these infants have high ketone body levels when BMs are low.

Likely that these alternative fuels protect them from neurological injury

###############################################

An emerging evidence base for the management of neonatal hypoglycaemia. (2017). Jane E Harding, Early Human development

Can take up to 3 days before normal blood sugars are reached

 FAILURE: can lead to hypoglycaemia  Most commonly occur in the first day of life  Transient hypo  May have hyperinsulinaemia which will persist and require interventions  Main focus is to reduce brain injury  Main source of energy

################################################

Other signs occur occasionally:

Due to catecholamine response - unusual in neonates except those with hyperinsulinaemia
• Pallor • Sweating • Tachycardia

Effects of hypoglycaemia on heart. Common following severe asphyxia
• Bradycardia • Hypotension • Heart failure • Cardiac arrest

######################################

Harris D, Weston P, Harding J. Incidence of neonatal hypoglycaemia in babies identified as being at risk. J Pediatr. 2012;161:787-91.

##################################

Note: Often there is a cluster of these signs

(ACoRN, 2012; CPS, 2013; McGowan, Price-Douglas, & Hay, 2006; Milcic & Nash, 2008; Rozance & Hay, 2006)

####################################

###############################################

################################

############################################

400% DEXTROSE GEL

Because the administration of glucose gel helps maintain normal glucose levels, a protocol using glucose gel reduces the necessity of supplemental feedings and therefore supports exclusive breastfeeding overall

#######################################

##################################

Glucose Levels One Hour After Administration of Dextrose Gel (n=278)

##############################

####################################

DO NOT WAIT FOR MORE THAN 5 MINS FOR CRITICAL LAB SAMPLE BEFORE TREATING

##################################

WHEN DO YOU SCREEN

SYMPTOMATIC OF HYPOGLYCEMIA

AT RISK

####################################

##############################

the National Health Service Litigation Authority reported over £162,166,677 in damages paid between 2002 and 2011 to neonatal hypoglycaemic patients who had suffered long-term deleterious neurodevelopmental outcomes.

Hawdon JM, Beer J, Sharp D, Upton M; NHS Improvement Patient Safety Programme ‘Reducing Term Admissions to Neonatal Units’. Neonatal hypoglycaemia: learning from claims. Arch Dis Child Fetal Neonatal Ed 2017;102:F110–F115.

#################################

NN hypoglycemia_It occurs in about 1 to 3 out of every 1,000 births

##########################