Practice Variations in Diagnosis and Treatment of Hypoglycemia in Asymptomatic Newborns

Abstract

OBJECTIVES: To describe variations in the practice of hypoglycemia screening and treatment in asymptomatic infants in the United States. METHODS: During the time period from February 2018 to June 2018, we surveyed representatives of hospitals participating in the Better Outcomes through Research for Newborns Network, a national research network of clinicians providing hospital care to term and late-preterm newborns. The survey included 22 questions evaluating practices related to hypoglycemia screening and management of asymptomatic infants. RESULTS: Of 108 network sites, 84 (78%) responded to the survey; 100% had a hypoglycemia protocol for screening at-risk infants in the well-baby nursery. There were wide variations between sites regarding the definition of hypoglycemia (mg/dL) (<45 [24%]; <40 [23%]; <40 [0–4 hours] and <45 [4–24 hours] [27%]; <25 [0–4 hours] and <35 [4–24 hours] [8%]), timing of first glucose check (<1 hour [18%], 1–2 hours [30%], 30 minutes post feed [48%]), and threshold glucose level for treatment (<45 [19%]; <40 [18%]; <40 [0–4 hours] and <45 [4–24 hours] [20%]; <25 [0–4 hours] and <35 [4–24 hours] [15%]). All respondents used breast milk as a component of initial therapy. Criteria for admission to the NICU for hypoglycemia included the need for dextrose containing intravenous fluids (52%), persistent hypoglycemia despite treatment (49%), and hypoglycemia below a certain value (37%). CONCLUSIONS: There is a significant practice variation in hypoglycemia screening and management across the United States.