G81 Postnatal management of hypoglycaemia – keeping mothers and babies together

Aim To keep mothers and babies together and decrease term hypoglycaemia admissions through implementation of a new guideline for management of healthy term babies with asymptomatic hypoglycaemia in the first 48 hours; in line with the British Association of Perinatal Medicine neonatal hypoglycaemia framework for practice, by the 1st of October 2018. Methods Hypoglycaemia threshold in healthy term babies A multidisciplinary group was set up in the level 3 NNU. The guideline was disseminated using a ‘read and sign’ approach. A buccal dextrose monograph was developed. The blood gas analyser on labour ward was upgraded to allow neonatal sampling. Champions supported implementation through educational ‘buzz’ sessions and training videos. Test PDSAs were carried out, resulting in further training and guideline revision. Results Baseline data revealed that hypoglycaemia made up 4% of term admissions (2% full admissions, 2% short stay ≤4 hours {SS}). 37% of babies required IV fluids, 44% required nasogastric feeds and 19% were given oral formula top-up feeds. 41% of women intended to exclusively breastfeed, 7% were doing so at discharge. For quality assurance, a prospective audit of blood gas glucose and lab blood glucose was carried out. Our outcome measure is% of term admissions to NNU with hypoglycaemia. Since implementation there is a trend towards reduction in admissions - 2 SS admissions only. Our process measure is compliance with the hypoglycaemia bundle – currently 65%. Our balance measures are: any adverse events, incorrect protocol (term vs preterm) use and an increase in breastfeeding rates. 1 infant >48 hours with no hypoglycaemia risk factors was treated on this protocol. There has been no incorrect protocol use. 72% of women intended to breastfeed, 47% were exclusively breastfed at discharge. Conclusion There is a trend towards reduction in separation of mothers and babies. Bundle compliance requires ongoing work. Understanding barriers has been key to maintaining interdisciplinary staff engagement. There are ongoing challenges around equipment, the use of two different thresholds in term and preterm infants and avoiding person dependency.