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

Adharsh P Ponnapakkam1, Christina N Stine2, Kaashif A Ahmad3,4

  • 1Brooke Army Medical Center, Fort Sam Houston, TX, USA. adharsh.p.ponnapakkam.mil@mail.mil.

Journal of Perinatology : Official Journal of the California Perinatal Association
|August 10, 2019
PubMed

Insights

Combining early feeding, skin-to-skin contact, and dextrose gel did not decrease neonatal intensive care unit (NICU) admissions for asymptomatic hypoglycemia or increase exclusive breastfeeding rates. Cesarean delivery was linked to lower compliance and breastfeeding success.

Area of Science:

  • Neonatal care
  • Pediatrics
  • Public health interventions

Background:

  • Neonatal hypoglycemia is a common concern, potentially leading to NICU admission.
  • Early feeding, skin-to-skin contact, and dextrose gel are known to individually support breastfeeding and manage neonatal hypoglycemia.
  • Combining these interventions aims to improve outcomes for asymptomatic hypoglycemia and breastfeeding.

Purpose of the Study:

  • To evaluate the effectiveness of a bundled intervention for neonatal hypoglycemia.
  • To assess the impact on NICU admissions for asymptomatic hypoglycemia.
  • To determine the effect on exclusive breastfeeding rates at discharge.

Main Methods:

  • Implementation of a bundle including early feeding (within 1 hour), skin-to-skin contact (1 hour within 2 hours), and buccal 40% dextrose gel for infants with hypoglycemia.
  • Utilized the IHI Model for Improvement framework.
  • Monitored NICU admissions for asymptomatic hypoglycemia and exclusive breastfeeding rates.

Main Results:

  • High compliance (94%) with dextrose gel administration was achieved.
  • No significant changes were observed in exclusive breastfeeding rates at discharge.
  • No reduction in NICU admissions for asymptomatic hypoglycemia was detected.
  • Cesarean delivery emerged as a risk factor for lower compliance and breastfeeding failure.

Conclusions:

  • The bundled intervention, despite high adherence to dextrose gel use, did not reduce NICU admissions for asymptomatic hypoglycemia.
  • Exclusive breastfeeding rates at discharge remained unchanged post-intervention.
  • Cesarean delivery is an independent risk factor associated with challenges in implementing the bundle and achieving exclusive breastfeeding.
Abstract

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