Improving the Diagnosis of Neonatal Hypoglycemia in a Well-Baby Nursery

Point of care glucose (POCG) measurements, used for detecting neonatal hypoglycemia, can have variable accuracy. The appropriate diagnosis of neonatal hypoglycemia in babies with low POCG measurements involves confirmatory serum glucose (CSG) testing. At our institution, no babies with low POCG measurements had CSG testing in their evaluation of neonatal hypoglycemia over a three year period. Our aim was to increase the percentage of CSG testing in babies with a low POCG. A secondary aim was to decrease the percentage of low-risk, asymptomatic babies who received POCG testing. Interventions included the design and implementation of an evidence-based protocol for the diagnosis and management of neonatal hypoglycemia (cycle 1), along with supportive education for multi-disciplinary providers on best practices related to neonatal hypoglycemia (cycle 2). Data were analyzed using statistical process control. During Cycle 1, the percentage of CSG testing in babies with POCG ≤40 mg/dL significantly increased from 0 to 33%, and increased further to 63% during Cycle 2. The initial gain was sustained over 2 years. The percentage of POCG testing among low-risk asymptomatic babies was 40% at baseline and did not change during the project period. 18 babies with low POCG results were spared from a diagnosis of neonatal hypoglycemia based on CSG testing. Implementation of a neonatal hypoglycemia protocol, along with supportive education, significantly improved rates of CSG testing, but not POCG overutilization, in our newborn population. Factors related to POCG overutilization should be further explored.