A Project to Implement Use of 40% Dextrose Gel for Transient Neonatal Hypoglycemia

To examine the effect of oral dextrose gel and oral feedings on newborns’ blood sugar homeostasis in the first day of life in an effort to decrease transfers to the NICU. Evidence-based practice project. Obstetric service at a large hospital in northeast Ohio with approximately 5,300 births annually. Neonates who experienced hypoglycemia were often transferred to the NICU for management if treatment measures failed, thereby increasing the cost of care and separating mothers from their newborns. During 2018, there were 54 neonates transferred to the NICU for hypoglycemia. Pediatricians, neonatologists, neonatal nurse practitioners, clinical nurse specialists, managers, educators, and registered nurses. An interdisciplinary task force created a nurse-driven protocol and associated order set and also created and provided interdisciplinary education to all involved caregivers using a multimodal approach. Neonates’ charts were audited for the time period of April 2019 to April 2020 to evaluate participants’ compliance with the prescribed practice changes. The number of neonates who qualified for blood glucose testing per the new protocol totaled 1,369. Of these, 188 (14%) met criteria for and were treated with 40% dextrose gel. Treatment with 40% dextrose gel was unsuccessful for 25 neonates, who were then transferred to the NICU. This is 29 fewer than were transferred in 2018. The use of oral dextrose gel and oral feedings was associated with a decrease in the number of newborns transferred to a higher level of care for treatment of hypoglycemia. Implementation of a neonatal hypoglycemia protocol including use of 40% dextrose gel was associated with a reduced number of neonates transferred to a higher level of care for treatment of hypoglycemia.