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Innovations and Challenges of Implementing a Glucose Gel Toolkit for Neonatal Hypoglycemia

Hammer, Denise, DNP, RNC-NIC; Pohl, Carla, DNP, APRN, CNM; Jacobs, Peggy J., DNP, APRN, CNM, RNC-OB; Kaufman, Susan, MS, RNC-MNN; Drury, Brenda, MSN, RNC-MNN

Section Editor(s): Harris-Haman, Pamela A. DNP, CRNP, NNP-BC; ; Zukowsky, Ksenia PhD, APRN, NNP-BC;

doi: 10.1097/ANC.0000000000000527
Clinical Issues in Neonatal Care

Background: Transient neonatal hypoglycemia occurs most commonly in newborns who are small for gestational age, large for gestational age, infants of diabetic mothers, and late preterm infants. An exact blood glucose value has not been determined for neonatal hypoglycemia, and it is important to note that poor neurologic outcomes can occur if hypoglycemia is left untreated. Interventions that separate mothers and newborns, as well as use of formula to treat hypoglycemia, have the potential to disrupt exclusive breastfeeding.

Purpose: To determine whether implementation of a toolkit designed to support staff in the adaptation of the practice change for management of newborns at risk for hypoglycemia, that includes 40% glucose gel in an obstetric unit with a level 2 nursery will decrease admissions to the Intermediate Care Nursery, and increase exclusive breastfeeding.

Method: This descriptive study used a retrospective chart review for pre/postimplementation of the Management of Newborns at Risk for Hypoglycemia Toolkit (Toolkit) using a convenience sample of at-risk newborns in the first 2 days of life to evaluate the proposed outcomes.

Results: Following implementation of the Toolkit, at-risk newborns had a clinically but not statistically significant 6.5% increase in exclusive breastfeeding and a clinically but not statistically significant 5% decrease in admissions to the Intermediate Care Nursery.

Implications for Practice: The Toolkit was designed for ease of staff use and to improve outcomes for the at-risk newborn.

Implications for Research: Future research includes replication at other level 2 and level 1 obstetric centers and investigation into the number of 40% glucose gel doses that can safely be administered.

Mennonite College of Nursing, Illinois State University, Normal (Drs Hammer and Pohl and Ms Drury); Advocate BroMenn Medical Center, Normal, Illinois (Drs Hammer and Jacobs and Mss Kaufman and Drury); and School of Nursing, Illinois Wesleyan University, Bloomington (Dr Jacobs).

Correspondence: Denise Hammer, DNP, RNC-NIC, Mennonite College of Nursing, Illinois State University, Campus Box 5810, Normal, IL 61790 (

Work occurred at: Advocate BroMenn Medical Center, Normal, Illinois.

The authors declare no conflicts of interest.

© 2018 by The National Association of Neonatal Nurses