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Presented To Department of Nursing March 5, 2008 Carol Burke, APN

Evidenced Based Practice Neonatal Hypoglycemia. Presented To Department of Nursing March 5, 2008 Carol Burke, APN. Teamwork pays off with hypoglycemia protocol!.  Identification of babies at risk  Assistance with feeding  Compliance to protocol from 19% to 85%.

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Presented To Department of Nursing March 5, 2008 Carol Burke, APN

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  1. Evidenced Based Practice Neonatal Hypoglycemia Presented To Department of Nursing March 5, 2008 Carol Burke, APN

  2. Teamwork pays off with hypoglycemia protocol! Identification of babies at risk  Assistance with feeding  Compliance to protocol from 19% to 85% Keep up the excellent work •  admissions from 116 to 35 to NICU related to hypoglycemia in 1 month! • Moms and babies stay together • Better glucose control for babies Recognizing quality patient care and nursing excellence, the ultimate benchmark patients can expect to receive

  3. Evidenced Based Practice • A problem-solving approach utilizing the current best evidence in making decisions about patient care. • Evaluate and revise current nursing practice based on research and expert opinion and standards of practice.

  4. Glucose Stabilization Hey, you could have shared some glucose

  5. Continuous supply of maternal glucose via placenta

  6. Mean glucose reading IDM can be a very low glucose reading

  7. Glucose Stabilization after Birth Reserves needed in immediate neonatal period when transfer of glucose is abruptly stopped Normal newborn Glucose at PWH is > 55mg/dL Hours of age

  8. Glucometer accuracy 75% of the time, the glucometer overestimates blood glucose +10mg/dL 55 May be 45

  9. Neonates “at risk” for hypoglycemia Too much insulin? IDM & LGA Too much insulin Too few reserves? Preterm SGA, IUGR Too few reserves Too much demand? Resuscitation, Hypothermia Tachypnea Sepsis Too much demand

  10. Can we do anything to minimize the drop in glucose? Maybe

  11. Research shows Keeping baby warm and early feedingwill minimize the decrease in blood sugar Glucose fall is potentially decreased

  12. Nursing practice priorities immediately after birth For ALL babies • NRP stabilization • Keep baby warm – skin to skin • Feed baby within 30-60 minutes Glucose is primary fuel for brain function

  13. A status check on glucose stability When to assess glucose? Check glucose before this feeding Check glucose before this feeding Feed first Hours of age

  14. Schedule for feeding and glucose measurement  = feed BEFORE glucose check X = feed AFTER glucose check

  15. If ANY glucometer reading is 55 or less the infant just bought a ticket to the Intervention Pathway

  16. Intervention Pathway Newborn on protocol NICU ANY Glucose check <40mg/dL 1 Formula Feed 10ml/Kg Significant Hypoglycemia

  17. Intervention Pathway Newborn on protocol NICU Second glucose reading After the feeding is > 55 Glucose check 40-49mg/dL Second glucose reading Is < 55 mg/dL 1 Formula Feed 10ml/Kg Wait 30 minutes, then recheck glucose Moderate Hypoglycemia

  18. Intervention Pathway Newborn on protocol Glucose > 55 NICU Glucose check 50 - 55mg/dL 3rd reading Second reading remains < 55 Third reading remains < 55 Wait 30 minutes, then recheck glucose 1 2 Breastfeed or Formula Feed Formula Feed 10ml/Kg Wait 30 minutes, then recheck glucose

  19. Cleanse site with alcohol prep. Wipe DRY with sterile gauze pad. Warm site with soft cloth, moistened with warm water up to 100, or use heel warmer for 3-5 minutes Puncture skin, wipe off first drop of blood with sterile gauze Hatched area indicates safe areas for puncture site. use second drop of blood

  20. Compliance with Hypoglycemia Protocol New Hypoglycemia Protocol implemented Privileged and Confidential Under the Illinois Medical Studies Act

  21. Summary • Moms and babies stay together • Stabilized glucose control for babies •  Identification of babies at risk •  Assistance with feeding •  Compliance to protocol from 19% to 85% •  admissions to NICU • Incidence of hypoglycemia congruent with expected volume

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