TOP 31 - SWEET: Standardized Workflow to Enhance Early Treatment and Reduce Hypoglycemia in Neonates

Publication Number: 3760.TOP 31

Megan R. Trejo, University of Virginia School of Medicine, Charlottesville, VA, United States; Presley S. Volkema, Valley Health, Winchester, VA, United States; Nicholas Heitkamp, University of Virginia School of Medicine, Crozet, VA, United States; Santina Zanelli, University of Virginia, Charlottesville, VA, United States; Jaclyn Wiggins, University of Virginia School of Medicine, Charlottesville, VA, United States

Background: Hypoglycemia is one of the most common metabolic disturbances seen in extremely preterm infants. In the first hours after birth, it is especially difficult for these infants to maintain euglycemia without exogenous glucose due to low glycogen stores. This initiative aims to decrease the incidence of hypoglycemia in extremely premature infants by increasing the efficiency of intravascular line placement and timeliness of IV dextrose initiation.

Objective: To reduce the incidence of hypoglycemia in preterm infants < 28 weeks’ gestation born at the University of Virginia (UVA) through standardized protocol implementation and multidisciplinary practice change to increase the efficiency of line placement and intravenous fluid (IVF) initiation.

Design/Methods: This IRB exempt quality initiative began with retrospective review of all inborn infants 22 0/7-27 6/7 weeks’ gestation (n=125) admitted between 2020-2022 to the UVA level IV NICU. Baseline data highlights delay in initial glucose measurement with a mean of 89 minutes and elevated rates of hypoglycemia at 19.2%. A series of 4 quality improvement cycles completed between 2023-2025 address barriers leading to delays in IV placement and IVF initiation through (1) administration of IVF through umbilical venous catheters (UVC) prior to placement confirmation with x-ray, (2) peripheral IV placement attempts x 2 in the delivery room with use of newly acquired 26G catheters, (3) implementation of a fellow navigator tool to define roles and delegate admission tasks to prevent delays in line placement, (4) utilization of an APGAR timer at the beginning of the UVC attempt to prompt additional providers to assist after 15 minutes if access is not obtained. Primary outcome measures include time to obtain initial screening glucose, time to establish peripheral or central intravascular access, and time to initiate dextrose containing fluids. All collected data from 2023-2025 (n=103) is currently undergoing analysis using subgroups in process control to understand the impact of recent interventions and guide further improvement.