Presented at the Neonatal Society 2016 Summer Meeting.
Deshpande S, Upton M, Hawdon J
Maternity & Newborn, NHS Improvement, Skipton House Area 6C, London SE1 6LH
Background: Admissions of term newborn infants to the 163 English neonatal units increased by 31% between 2011 and 2014 despite a 3.6% decrease in term live births. Hypoglycaemia was the third most common reason for these admissions. This retrospective analysis of anonymised patient-level data was undertaken to determine the characteristics of hypoglycaemia-related term neonatal admissions, and assess the potential for avoiding unnecessary admissions and mother-infant separation at a critical period of bonding.
Methods: Anonymised patient-level data for term (gestation ≥37 weeks) neonatal admissions in England during 2011-13 were obtained using routinely collected data from Neonatal Data Analysis Unit. Their care was assessed using the current guidance for prevention and management of neonatal hypoglycaemia1, 2. Details of term neonatal live births during the same time period were obtained from the Office of National Statistics. Funding for obtaining data was provided by NHS Improvement (formerly Patient Safety).
Results: During this period, there were 13136 admissions of term neonates for hypoglycaemia, accounting for 9.9% and 0.7% of all term neonatal admissions and term live births respectively. Babies born at 37-38 weeks of gestation and those born by caesarean section were overrepresented accounting for 55% and 48% respectively of these admissions. 39% of admissions occurred in infants deemed low-risk for hypoglycaemia (no recorded maternal medical or obstetric problems, birth weight of 2500-4000 g, and good condition at birth). Admission blood glucose of <2.6 mmol/L was significantly more common in babies who were hypothermic on admission than among the normothermic infants (71.3% vs. 56.8%, p<0.001). 30% of admissions took place within 4 hours of birth with half of these occurring in an hour of birth with 71% of them being admitted directly from the delivery suites/theatre. These babies generated over 76,000 care days with special care category accounting for ~80%.
Conclusion: Infants born at early term, delivered by caesarean section and those who are hypothermic are particularly at increased risk of admission for hypoglycaemia. Admissions of babies at low risk of hypoglycaemia in whom blood glucose would not normally be measured, and during the period of early metabolic transition suggest inadequate compliance with current guidance for prevention and management of hypoglycaemia in such infants.
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1. http://www.unicef.org.uk/Documents/Baby_Friendly/Guidance/hypo_policy.pdf?epslanguage=en(accessed 19 May 2016).
2. Deshpande S, Ward Platt MP. The investigation and management of neonatal hypoglycaemia. Semin Fetal Neonatal Med 2005;10:351-61.