262 - The Burden of ‘Pokes’ in Newborns with Hypoglycemia Who Require IV Dextrose

Publication Number: 262.6620

Adam Frymoyer, Stanford University School of Medicine, Palo Alto, CA, United States; Erika M. Monasch, Stanford University School of Medicine, Palo Alto, CA, United States; Ming Yeh Lee, Stanford University School of Medicine, Palo Alto, CA, United States; David Maahs, Stanford University School of Medicine, Palo Alto, CA, United States

Background: Neonatal hypoglycemia is one of the most common reasons for NICU admission in otherwise healthy late preterm and term newborns with 4-14% of those ‘at risk’ (e.g. late preterm, small and large for gestational age, infant of diabetic mother) requiring IV dextrose. Frequent blood glucose measurements, typically via painful heel lances, are required to titrate IV dextrose to maintain euglycemia during treatment. However, greater exposure to painful procedures in the neonatal period is associated with negative long-term neurodevelopmental outcomes. The burden of blood glucose measurements in newborns with neonatal hypoglycemia requiring IV dextrose is unknown.

Objective: To examine the number of blood glucose measurements and length of stay in newborns with hypoglycemia admitted to the NICU for IV dextrose.

Design/Methods: Retrospective study (07/2018 to 07/2024) of newborns ≥35 weeks gestation who had hypoglycemia screening in a university-affiliated newborn nursery and subsequently required NICU admission for IV dextrose due to hypoglycemia. AAP guidelines for glucose screening and target glucose levels (≥35 mg/dl for < 4 h of life; ≥45 mg/dl for >4 h of life) were followed. If target glucoses were not achieved after 3 ‘doses’ of buccal dextrose gel ± oral supplementation, IV dextrose was initiated. Blood glucoses were measured via heel lance and point of care glucometers. Newborn characteristics, number of glucose measurements, and length of stay were captured from the medical record and available as part of a limited dataset from a QI project on neonatal hypoglycemia. Descriptive statistics and between group comparisons were performed.

Results: Over the 73-month study period, 7,823 newborns were screened for hypoglycemia in the newborn nursery, of whom, 298 (3.8%) required IV dextrose and were admitted to the NICU. Newborns requiring IV dextrose had a lower gestational age and birthweight and were more likely to be an infant of a diabetic mother (Table 1). Newborns who received IV dextrose experienced a median of 29 (IQR 19-40) glucose measurements while hospitalized. Over 25% of newborns had ≥40 glucose measurements and almost half had ≥30 glucose measurements (Figure 1). The median length of stay was 6 (IQR 4-9) days.

Conclusion(s): Newborns with hypoglycemia requiring admission to the NICU for IV dextrose experience a high burden of painful ‘pokes’, and most are hospitalized for 6 days or more. Further research is needed to improve the care of this population, such as through the use of continuous glucose monitoring to reduce pain from frequent ‘pokes’.

Table 1. Patient characteristics of 'at Risk' Newborns Screened for Hypoglycemia


Figure 1. Number of blood glucose checks in newborns ≥35 weeks gestation who had hypoglycemia screening in a university affiliated newborn nursery and subsequently required NICU admission for IV dextrose due to persistent hypoglycemia (n=298).


Table 1. Patient characteristics of 'at Risk' Newborns Screened for Hypoglycemia


Figure 1. Number of blood glucose checks in newborns ≥35 weeks gestation who had hypoglycemia screening in a university affiliated newborn nursery and subsequently required NICU admission for IV dextrose due to persistent hypoglycemia (n=298).