053 - Decreasing NICU admission for high-risk neonates with hypoglycemia needing treatment with oral glucose gel : A quality improvement project

Publication Number: 53.4069

Navnoor Singh, Southern Illinois University School of Medicine, Springfield, IL, United States; Navnoor Singh, Southern Illinois University School of Medicine, Springfield, IL, United States; Saskia D'Sa, University of Alabama Birmingham, Birmingham, AL, United States; Melanie Nielsen, Southern Illinois University School of Medicine, Carbondale, IL, United States; Sheref Unal, Southern Illinois University School of Medicine, Springfield, IL, United States; Sara Catalano, HSHS St Johns Children's Hospital, Raymond, IL, United States; Dharmendra J. Nimavat, Southern Illinois University School of Medicine, Springfield, IL, United States; Beau J.. Batton, SIU, Springfield, IL, United States; Venkata S. Majjiga, SIU School of Medicine, Chatham, IL, United States; Magali Jean-Louis, SIU School of Medicine, Springfield, IL, United States

Background: NICU admissions have been shown to have a negative impact on mother-infant bonding and to interfere with establishment of effective breastfeeding. Oral glucose gel is considered an effective, safe, and non-invasive way to manage neonatal hypoglycemia (NH) and to reduce NICU admissions. Introduction of oral glucose gel in our NICU did not result in similar outcome, and led to the development of this QI with aim to decrease NICU admission in infants who received glucose gel for the management of neonatal hypoglycemia.

Objective: To reduce NICU admission for hypoglycemia in at risk infants (SGA, LGA, late preterm, infants of diabetic mothers) who received glucose gel by 25% over 1 year

Design/Methods: Our baseline data revealed that, in babies receiving glucose gel for treatment of hypoglycemia, the percentage of NICU admission was 28%. Nursing education was undertaken regarding: methods for glucose gel administration (dose, number of aliquots, technique of application) and for optimal accucheck collection (prewarming of the heel, waiting for alcohol applied to clean the skin to dry prior to any heel stick, avoiding infant hypothermia). The first PDSA cycle started in July 2023, subsequent PDSA cycles occurred every 3 to 4 months thereafter and, sustainability phase started in July 2024. At the end of each PDSA cycle, Pareto Charts were used to assess process measures and to guide targeted staff reeducation.

Results: During this QI, a total of 3,080 babies were delivered and, 493 babies at risk for hypoglycemia received glucose gel. At the end of the first year, NICU admission for hypoglycemia in high risk infants who received glucose gel for hypoglycemia dropped by 43% (28% to 16%), as shown in figure 1 (Control chart illustrating the effect of each PDSA cycles on percentage of NICU admissions). Figure 2 shows the Pareto charts used in this QI. There was no incidence of hyperthermia during the period of the study (Balancing measure).

Conclusion(s): Identification of process measures requiring improvement and subsequent targeted staff education significantly decreased our NICU admission for NH. Exclusive breastfeeding rates post QI did not increase.

Percentage of NICU admissions for hypoglycemia in at-risk babies receiving glucose gel - Control chart


Pareto Charts for each PDSA cycle


Percentage of NICU admissions for hypoglycemia in at-risk babies receiving glucose gel - Control chart


Pareto Charts for each PDSA cycle