A feed-centric hypoglycaemia pathway ensures appropriate care escalation in at-risk infants.

Autor:	Chandran S; Department of Neonatology, KK Women's and Children's Hospital, Singapore suresh.chandran@singhealth.com.sg.; Paediatric Academic Clinical Programme, Lee Kong Chian School of Medicine, Singapore.; Paediatric Academic Clnical Programme, Duke NUS Medical School, Singapore., Siew JX; Division of Medicine, KK Women's and Children's Hospital, Singapore., Rajadurai VS; Department of Neonatology, KK Women's and Children's Hospital, Singapore.; Paediatric Academic Clinical Programme, Lee Kong Chian School of Medicine, Singapore.; Paediatric Academic Clnical Programme, Duke NUS Medical School, Singapore., Lim RWS; Department of Medicine, Tan Tock Seng Hospital, Singapore., Chua MC; Department of Neonatology, KK Women's and Children's Hospital, Singapore.; Paediatric Academic Clinical Programme, Lee Kong Chian School of Medicine, Singapore.; Paediatric Academic Clnical Programme, Duke NUS Medical School, Singapore., Yap F; Paediatric Academic Clinical Programme, Lee Kong Chian School of Medicine, Singapore.; Division of Paediatric Endocrinology, KK Women's and Children's Hospital, Singapore.
Jazyk:	angličtina
Zdroj:	BMJ open quality [BMJ Open Qual] 2021 Dec; Vol. 10 (4).
DOI:	10.1136/bmjoq-2020-001296
Abstrakt:	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. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu