Management of neonatal hypoglycaemia in a tertiary maternity unit-A multidisciplinary quality improvement project.

AIM: Improved identification and treatment of infants at risk of hypoglycaemia using evidence-based guidelines. METHODS: Design: Prospective, multidisciplinary quality improvement project (QIP). SETTING: Tertiary maternity hospital, Dublin (2016-2023). SUBJECTS: Infants at risk for neonatal hypoglycaemia. INTERVENTION: Plan-Do-Study-Act methodology. A hospital-wide survey and ongoing audit informed our initiatives including staff education, antenatal maternal education and standardisation of equipment. Our guidelines were continually evaluated and updated based on emerging evidence. MAIN OUTCOME MEASURES: Neonatal unit (NNU) admissions, adherence to guidelines and use of glucose gel. RESULTS: NNU admissions decreased by 70%, from 3% (118/3883) to 0.9% (34/3806 infants). The number requiring an IV glucose bolus reduced from 25% (29/118) to 6% (2/34). Improved antenatal education, antenatal expression of colostrum and early and frequent feeding also contributed to a reduction in glucose gel use of 94% (1009 tubes in 2018-v-62 in 2022). There were no adverse side effects related to hypoglycaemia. CONCLUSION: Our QIP resulted in a significant reduction in NNU admissions leading to significant cost reductions and NNU workload. More importantly, this resulted in less maternal-infant separation and potentially less parental anxiety and a more supportive environment for breastfeeding. These low-cost initiatives can be implemented in other tertiary maternity hospitals to improve maternity and newborn care.