The NICU at Utah Valley Regional Medical Center was accustomed to admitting two to three newborns a day for low blood sugar (hypoglycemia), until nurses in the unit took it upon themselves to see if they could lower that statistic. The nurses recommended three changes to the hypoglycemia treatment protocol, and since their recommendations were implemented in March, only seven babies have been admitted to the NICU for hypoglycemia.
"Our goal is always to keep babies with their mothers if possible. The changes in the hypoglycemia protocol have allowed this to happen without causing any new problems for our patients," said Dr. Ken Richardson, MD, PhD, a neonatologist at Utah Valley Regional. “In the years to come, many babies will benefit because of this new treatment protocol.”
The first change the nurses recommended to the protocol was to make sure babies weren’t being tested for low blood sugar until at least six hours after birth. Babies naturally experience a drop in blood sugar after the umbilical cord is cut because they are no longer receiving glucose from their mother. Given enough time, many babies are able to regulate their blood sugar levels on their own, keeping them out of the NICU.
Secondly, the nurses began applying a glucose gel directly to the baby’s buccal cavity (the area between the gums and cheeks) to raise blood sugar to normal levels. This treatment is used in older diabetic patients, but had not been used before in newborns. In fact, babies with low blood sugar were being treated with an IV bolus. The gel is a much less invasive treatment and can be applied up to three times before the baby needs to be transferred to the NICU.
Lastly, the nurses recommended that only babies with blood sugar readings of 40 or lower be admitted to the NICU. Previously, babies with readings of 45 or lower were admitted, but the nurses found that, in general, only the babies with sugars below 40 were having hypoglycemic reactions. Changing the blood sugar admission level allowed the babies to remain with their parents and gave the babies time to respond to treatment.
Making these three changes to the hypoglycemia treatment protocol has helped keep babies out of the NICU, allowing the babies to remain with their parents while they’re in the hospital, and reducing the length of their hospital stay. Although the new protocol is only being practiced at Utah Valley Regional, Intermountain Healthcare plans to adopt it throughout the system because of its high success rate.
More and more babies are stay close by their mothers after birth rather than heading to the Newborn Intensive Care Unit, thanks to a new protocol developed by a group of innovative nurses.