Adharsh Ponnapakkam1,2, Donald Rees3, Maria Cristina Gallup4, Kaashif A Ahmad5,6,7,8, Dena Miller3, Angela Fagiana9, Nicholas R Carr5,10. 1. Department of Pediatrics, Brooke Army Medical Center, San Antonio, TX, USA. adharsh.p.ponnapakkam.mil@mail.mil. 2. Department of Pediatrics, Uniformed Services University of Health Sciences, Bethesda, MD, USA. adharsh.p.ponnapakkam.mil@mail.mil. 3. Department of Pediatrics, Brooke Army Medical Center, San Antonio, TX, USA. 4. Mayo Clinic, Rochester, MN, USA. 5. Department of Pediatrics, Uniformed Services University of Health Sciences, Bethesda, MD, USA. 6. Pediatrix Medical Group of San Antonio, San Antonio, TX, USA. 7. Baylor College of Medicine, San Antonio, TX, USA. 8. Gulf Coast Neonatology, Houston, TX, USA. 9. Pediatrix Medical Group of Savannah, Savannah, GA, USA. 10. Department of Pediatrics, Division of Neonatology, University of Utah Health, Salt Lake City, UT, USA.
Abstract
OBJECTIVE: To study the effects of a supplementation-based hypoglycemia guideline including donor (DM) on NICU admission, exclusive breastfeeding, and blood glucose concentrations in infants at-risk for neonatal hypoglycemia (NH). PROJECT DESIGN: We integrated DM, feeding supplementation, and reduced frequency of blood glucose testing into an NH bundle for term and late-preterm newborns. We then examined NICU admission rates and rates of exclusive breastfeeding at discharge. RESULTS: NICU admission rates were reduced to 6% (-10%). Exclusive breastfeeding rates increased to 55% (+22%). Median cost of DM utilization was $13.73 per patient with an average volume of 50.8 ml/infant. DM supplementation resulted in similar times to last hypoglycemic episode and greater increases in blood glucose compared to expressed breast milk or breastfeeding alone (+9.6 mg/dL, p < 0.05). CONCLUSIONS: A supplementation-based hypoglycemia guideline including donor milk may be an effective way to reduce NICU admissions for asymptomatic hypoglycemia and support mothers in achieving breastfeeding goals.
OBJECTIVE: To study the effects of a supplementation-based hypoglycemia guideline including donor (DM) on NICU admission, exclusive breastfeeding, and blood glucose concentrations in infants at-risk for neonatal hypoglycemia (NH). PROJECT DESIGN: We integrated DM, feeding supplementation, and reduced frequency of blood glucose testing into an NH bundle for term and late-preterm newborns. We then examined NICU admission rates and rates of exclusive breastfeeding at discharge. RESULTS: NICU admission rates were reduced to 6% (-10%). Exclusive breastfeeding rates increased to 55% (+22%). Median cost of DM utilization was $13.73 per patient with an average volume of 50.8 ml/infant. DM supplementation resulted in similar times to last hypoglycemic episode and greater increases in blood glucose compared to expressed breast milk or breastfeeding alone (+9.6 mg/dL, p < 0.05). CONCLUSIONS: A supplementation-based hypoglycemia guideline including donor milk may be an effective way to reduce NICU admissions for asymptomatic hypoglycemia and support mothers in achieving breastfeeding goals.