PSHP 2026 Residency Conference

This study aimed to assess the rate of neonatal intensive care unit (NICU) admissions prior to addition of oral dextrose gel (ODG) to an internal treatment protocol for neonatal hypoglycemia. This was a single center retrospective review assessing the protocol without ODG. Inclusion criteria were gestational age ≥ 35 weeks, birth weight > 2 kg, and no other indication for NICU admission, pertinent exclusion criteria included receiving ODG. The primary outcome assessed was rate of NICU admission for neonatal hypoglycemia treatment and was descriptively compared to previously reviewed data for an internal treatment protocol with ODG. Secondary outcomes were resolution of hypoglycemia ≤ 60 minutes, length of stay (LOS) (hospital and NICU if applicable), and IV dextrose boluses administered. Additionally, data on maternal and fetal risk factors for severe hypoglycemia were collected. Data were extracted from the institutional electronic medical record (EMR) and REDCap was used for data storage. Statistical analysis utilized descriptive statistics. In the group without ODG, 285 charts were reviewed, 274 were excluded and 11 were included. Primary exclusion reason was an institutional EMR change limiting access to data needed to review eligibility criteria (n=157). In the protocol without ODG, 100% of patients were admitted to the NICU for hypoglycemia management with IV dextrose. In comparison, review of the protocol with ODG had a NICU admission rate of 27% (n=166). Total LOS in the without ODG protocol was a median (IQR) of 7 (6-13) days and NICU LOS was a median (IQR) of 7 (5-13) days. Three (27%) of 11 received dextrose boluses, none had resolution of hypoglycemia ≤ 60 minutes, and all received IV dextrose infusions. Results of this review demonstrated NICU admissions were frequent with the prior protocol and numerically higher compared to review done of the protocol with ODG. When not using ODG, feeds and dextrose boluses were unable to prevent IV dextrose infusions. Interpretation of results were limited by small sample size and access to data due to EMR change but will be useful for improving institutional management practices of neonatal hypoglycemia.