WIP 19 - A Quality Improvement Initiative to Increase Early Feeding in Neonates at Risk for Hypoglycemia

Publication Number: WIP 19.7481

Anna V. Gamble, Boston Children's Hospital, Cambridge, MA, United States; Lillian Juttukonda, Boston Children's Hospital, Boston, MA, United States; Julie Cadogan, Brigham and Women's Hospital, Boston, MA, United States; Karen Manganaro, Brigham and Women's Hospital, Kingston, MA, United States; Jennifer Riley, Brigham and Women's Hospital, Natick, MA, United States; Judy P. Brown, Brigham and Women's Hospital, Weymouth, MA, United States; Carmen Monthe-Dreze, Brigham and Women's Hospital, Boston, MA, United States

Background: Neonatal hypoglycemia (NH) is a common neonatal metabolic disturbance that poses significant risks including neurodevelopmental impairment and seizures. Studies estimate 30 to 50% of at-risk infants ≥ 35 weeks gestational age (GA) are admitted to the NICU for NH management, leading to maternal-infant separation, increased formula supplementation and invasive procedures. Early feeding may be an effective strategy to reduce NH risk, however rates of timely feeding remain low, especially in neonates born via cesarean section.

Objective: The specific aim is to increase early feeding rates within the first hour of life (HOL 1) among neonates at risk for NH from a baseline of 45% to 60% by December 2024.

Design/Methods: This project is being conducted in a single, tertiary-care academic medical center with a high-risk OB service and is exempt from IRB oversight. Infants with GA < 35 weeks, of multiple gestation, and with clinical instability precluding eligibility to receive early feeding are excluded. The quality improvement (QI) team evaluated key drivers and developed the following interventions: 1) implementation of a new bundle (early identification of at-risk infants, parental education prior to delivery, provision of pasteurized donor human milk [PDHM] to eligible infants, and delay of initial glucose screen and vitals/medications to the 2nd hour after birth to promote skin-to-skin and breastfeeding [BF]), 2) staff education, and 3) revision of PDHM processes. Data from January 2021 to December 2024 will be reviewed through an EPIC reporting tool. The primary outcome is the % of at-risk infants receiving feeding (BF, PDHM or formula) within 1 HOL. Secondary outcomes include rates of NH, number of hypoglycemic episodes per neonate, and NICU admission for NH. Process measures include assessment of nutrition plan prior to delivery and use of PDHM for initial feeds among BF dyads. We will utilize statistical process control charts, Kruskal-Wallis and chi-squared tests to evaluate changes in process, outcome, and balancing measures.