Burden of "Pokes" in Newborns With Hypoglycemia Who Require IV Dextrose

Neonatal hypoglycemia is one of the most common reasons for neonatal intensive care unit (NICU) admission in otherwise healthy late preterm and term newborns. Routine care requires frequent blood glucose (BG) measurements, typically via painful heel lances, to titrate intravenous (IV) dextrose during treatment. However, little is known about the care for these newborns including the burden of BG measurements.

This was a retrospective medical record review (July 2018 to July 2024) of newborns at least 35 weeks gestational age who had hypoglycemia screening in a university-affiliated newborn nursery and subsequently required NICU admission for IV dextrose. IV dextrose was initiated if target glucose levels per national guidelines were not achieved with buccal dextrose gel with or without oral supplementation. BG measurements before feeds typically via heel lance and point-of-care glucometers continued until euglycemia was achieved with enteral feeds alone. Descriptive statistics of newborn characteristics, number of BG measurements, and length of stay were analyzed.

Among 7823 newborns screened for hypoglycemia in the newborn nursery, 298 (3.8%) required IV dextrose and NICU admission. Newborns who received IV dextrose experienced a median 29 (IQR, 19-40) BG measurements while hospitalized. More than 25% of newborns had at least 40 BG measurements and almost half had at least 30 glucose measurements. The median length of stay was 6 (IQR, 4-9) days.

Newborns with hypoglycemia requiring IV dextrose experience a high burden of BG measurements. Evidence-based practices along with noninvasive glucose monitoring approaches that may safely reduce the number of painful "pokes" during clinical care should be investigated.