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Title: A feed-centric hypoglycaemia pathway ensures appropriate care escalation in at-risk infants
Authors: Chandran, Suresh
Siew, Jia Xuan
Rajadurai, Victor Samuel
Lim, Rachel Wei Shan
Chua, Mei Chien
Yap, Fabian
Keywords: Science::Medicine
Issue Date: 2021
Source: Chandran, S., Siew, J. X., Rajadurai, V. S., Lim, R. W. S., Chua, M. C. & Yap, F. (2021). A feed-centric hypoglycaemia pathway ensures appropriate care escalation in at-risk infants. BMJ Open Quality, 10(4), e001296-.
Journal: BMJ Open Quality 
Abstract: Background: There is a lack of clarity of what constitutes the starting point of a clinical pathway for infants at-risk of hypoglycaemia. Glucose-centric pathways (GCP) identify low glucose in the first 2 hours of life that may not represent clinical hypoglycaemia and can lead to inappropriate glucose management with infusions and medications. Objective: To study the impact of a feed-centric pathway (FCP) on the number of admissions for hypoglycaemia to level 2 special care nursery (SCN) and the need for parenteral glucose/medications, compared to GCP. Methods: This project was conducted over 2 years, before and after switching from a GCP to FCP in our institution. FCP involves skin-to-skin care, early breast feeding, checking glucose at 2 hours and use of buccal glucose. The primary outcome was the number of SCN admissions for hypoglycaemia. Secondary outcomes include the number of infants needing intravenous glucose, medications and length of SCN stay. Results: Of 23 786 live births, 4438 newborns were screened. We screened more infants at-risk for hypoglycaemia using the FCP (GCP:1462/11969, 12.2% vs FCP:2976/11817, 25.1%) but significantly reduced SCN admissions (GCP:246/1462, 16.8% vs FCP:102/2976, 3.4%; p<0.0001). Fewer but proportionally more FCP newborns required intravenous glucose (GCP: 136/246, 55% vs FCP: 88/102, 86%; p=0.000). Compared with GCP, FCP reduced the total duration of stay in SCN by 104 days per annum, reducing the cost of care. However, the mean length of SCN stay for FCP was higher (GCP:2.43 days vs FCP:3.49 days; p=0.001). There were no readmissions for neonatal hypoglycaemia to our institution. Conclusion: The use of FCP safely reduced SCN admissions, averted avoidable escalation of care and helped identify infants who genuinely required intravenous glucose and SCN care, allowing more efficient utilisation of healthcare resources.
ISSN: 2399-6641
DOI: 10.1136/bmjoq-2020-001296
Schools: Lee Kong Chian School of Medicine (LKCMedicine) 
Organisations: KK Women's and Children's Hospital
Duke NUS Medical School
Rights: © Author(s) (or their employer(s)) 2021. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:
Fulltext Permission: open
Fulltext Availability: With Fulltext
Appears in Collections:LKCMedicine Journal Articles

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