1224 Audit of neonatal hypoglycaemia in Whiston Hospital and study of incidental hypoglycaemia during sepsis screen

Published Date: 17th August 2022

Publication Authors: Alexopoulou V (STHK), Green J, Garr R

Aims
Babies at risk of hypoglycaemia should be identified at birth and placed on a care pathway that includes early commencement of feeds, regular glucose monitoring and clinical assessment. Our hospital has a hypoglycaemia policy for managing these babies and this project aims to examine current local practice through auditing against local hypoglycaemia guidelines. Also, we attempted to identify possible correlation between hypoglycaemia and sepsis screen and make recommendations about future clinical practice.

Methods
Medical handover lists and tracking lists completed by midwives were used in postnatal ward (PN), delivery suite (DS) and neonatal unit (NNU), in order to identify all the babies less than one week old, who were on the hypoglycaemia pathway or who were screened for sepsis between first to thirtieth of November two thousand twenty one. The patient records were examined during admission to extract: patient demographics, if hypoglycaemia pathway was printed and put in the notes, details of the feeds offered, details of the management of hypoglycaemia when occurred and the blood glucose (BM) at the time of the sepsis screen. Babies who were born in poor condition and required transfer in another hospital were not included.

Results
37 babies were commenced on hypoglycaemia pathway.

33 babies were in PN/DS and 4 babies were in NNU.

None of the babies in NNU had the hypoglycaemia pathway printed (100%).

4/33 babies in PN/DS (12%) were missed and hypoglycaemia pathway was not commenced.

22/33 babies in PN/DS (66%) had the hypoglycaemia pathway printed. 19/22 babies completed correctly all the hypoglycaemia pathway, with correct documentation of blood sugars, feeds offered and glucogel use. 2 babies had the pathway left blank. 1/22 baby was transferred in NNU from PN and hypoglycaemia pathway was discontinued after 2nd feed.

7/33 babies (21%) were not identified as inpatient and data collection attempted in retrospect from electronic records. In all 7 babies the hypoglycaemia proforma was not scanned and uploaded in the electronic records.

42 babies were screened for sepsis. (figure 2). At the time of the screen 3/42 babies had a BM ≤ 1.9, out of which 2 babies were not on hypoglycemia pathway - incidental hypoglycaemia during sepsis screen.

5/42 babies had a BM 2-2.5 and 15/42 babies had a BM ≥2.5.

9/42 babies did not have a documented BM.

Conclusion
PN/DS are doing well in following the hypoglycaemia pathway. However, a few babies are still missed and not monitored. For this reason, we are going to implement hypoglycaemia training for staff and add hypoglycaemia reminders in the wards. Hypoglycaemia pathway is not used in NNU, so we will create a hypoglycaemia proforma for NNU.

Sepsis is a risk factor for hypoglycaemia. Babies who are screened for sepsis should have their BM checked at the time of the screen and commence the hypoglycaemia pathway if it is low.

 

Alexopoulou, V; Green, J; Garr, R. (2022). 1224 Audit of neonatal hypoglycaemia in Whiston Hospital and study of incidental hypoglycaemia during sepsis screen. Archives of Disease in Childhood. 107(Suppl 2), p.A477. [Online]. Available at: https://adc.bmj.com/content/107/Suppl_2/A477.1 [Accessed 22 December 2022]

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