Medical Director, Newborn Nursery
Pediatric Hospitalist The University of Vermont Children's Hospital Burlington, Vermont, United States
Background: Transient neonatal hypoglycemia is a common problem in the newborn nursery (NBN). Newborns at increased risk for neonatal hypoglycemia include: large for gestational age (LGA), small for gestational age (SGA), infants of diabetic mothers (IDM), and prematurity ( < 37 weeks). Within the hospital setting, use of hypoglycemia protocols play a key role in the identification, monitoring, and treatment of these at risk patients. In May of 2024, our team integrated the use of 40% glucose gel as the first line therapy for newborn hypoglycemia; replacing donor human milk (DHM) as the first line substrate within our protocol. Objective: Our primary objective was to compare newborn supplementation rates in infants born over a 1-year period pre and post integration of glucose gel into our NBN hypoglycemia protocol. Design/Methods: We conducted a retrospective chart review from 5/15/23-5/15/25. This study was IRB exempt. Hypoglycemia was defined as < 40 mg/dL at < 4 hours of life and < 45 mg/dL at > 4 hours of life. All newborns admitted to NBN who developed hypoglycemia were included. Patients were excluded from analysis on supplementation if they were transferred to the NICU. Results: 667 newborns entered the hypoglycemia protocol (pre-gel) compared to 713 newborns (post-gel). Our analysis reflected a 15% drop in supplementation rates from 82% in the pre-gel integration group gel to 67% in the group who received glucose gel (p=0.0014, 95% CI: 0.793-0.847; 0.634-0.706). Change in supplementation rate was then evaluated by newborn growth for gestational age at birth. There was no statistical difference found in the LGA or AGA groups, however, results showed a statistical difference among the SGA group with a 31% decrease in supplementation rates post gel (p < 0.0001). Data analysis found that median value for newborns (N=171) who received glucose gel was 1 dose (range 1-5, 92% receiving < 2 doses) for those who remained in NBN compared to a median of 2 doses (range 1-9, 52 % received < 2 doses) of glucose gel for newborns requiring NICU transfer (N=19). This difference was statistically significant using a Mann Whitney U test (z = -4.1, p< 0.001). Limitations: retrospective review, NICU transfers may have other co-morbidities, and families may have chosen early supplementation.
Conclusion(s): Our results suggest that glucose gel may decrease DHM/formula supplementation rates and allow families to exclusively breastfeed during this transitional period. Additional prospective studies are needed to further evaluate the impact of glucose gel on newborn supplementation rates.
