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A feed-centric hypoglycaemia pathway ensures appropriate care escalation in at-risk infants

Suresh Chandran1,2,3, Jia Xuan Siew4, Victor Samuel Rajadurai5,2,3

  • 1Department of Neonatology, KK Women's and Children's Hospital, Singapore suresh.chandran@singhealth.com.sg.

BMJ Open Quality
|December 18, 2021
PubMed

Insights

A feed-centric pathway (FCP) for at-risk infants significantly reduced special care nursery (SCN) admissions for neonatal hypoglycemia compared to glucose-centric pathways (GCP). FCP improved resource utilization while identifying infants needing genuine intervention.

Area of Science:

  • Neonatal Medicine
  • Pediatric Endocrinology
  • Clinical Pathway Development

Background:

  • Current clinical pathways for neonatal hypoglycemia often lack clarity on the initial management trigger.
  • Glucose-centric pathways (GCP) may lead to over-management of infants with transient low glucose levels, not true clinical hypoglycemia.
  • This highlights a need for refined pathways to ensure appropriate care for at-risk newborns.

Purpose of the Study:

  • To evaluate the impact of a feed-centric pathway (FCP) on special care nursery (SCN) admissions for neonatal hypoglycemia.
  • To compare the need for parenteral glucose and medications under FCP versus GCP.
  • To assess the efficiency of healthcare resource utilization with FCP implementation.

Main Methods:

  • A 2-year study comparing a glucose-centric pathway (GCP) with a subsequent feed-centric pathway (FCP).
  • FCP included skin-to-skin care, early breastfeeding, and targeted glucose monitoring.
  • Primary outcome: SCN admissions for hypoglycemia; Secondary outcomes: need for intravenous glucose/medications, length of SCN stay.

Main Results:

  • FCP significantly reduced SCN admissions for hypoglycemia (3.4% vs 16.8%) despite screening more infants.
  • While a higher proportion of FCP infants required intravenous glucose (86% vs 55%), overall SCN admissions decreased substantially.
  • FCP reduced total annual SCN stay duration by 104 days, indicating improved resource efficiency, though mean individual stay was longer.

Conclusions:

  • The feed-centric pathway (FCP) safely reduces special care nursery admissions for neonatal hypoglycemia.
  • FCP effectively identifies infants requiring genuine intervention, averting unnecessary escalation of care.
  • Implementation of FCP optimizes healthcare resource utilization in managing at-risk newborns.
Abstract

Keywords:
diabetes mellitushealthcare quality improvementpaediatrics

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