Alsweiler Jane M, Gomes Leanora, Nagy Tess, Gilchrist Catherine A, Hegarty Joanne E
Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand.
Neonatal Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand.
J Paediatr Child Health. 2020 Jan;56(1):148-154. doi: 10.1111/jpc.14544. Epub 2019 Jun 22.
To determine if the routine use of automatically calculated birthweight centiles prior to discharge from the delivery unit is associated with improved adherence to the neonatal hypoglycaemia guideline.
We conducted retrospective audits of adherence to the neonatal hypoglycaemia guideline in a tertiary maternity hospital in Auckland, New Zealand in a randomly selected cohort of newborn infants at risk of neonatal hypoglycaemia before (2011) and after (2015) the introduction of routine use of calculated birthweight centiles for all infants. The primary outcome was adherence to the guideline, defined as (i) blood glucose concentration screening in the first 48 h after birth; (ii) the initial measurement taken 1-2 h after birth; and (iii) at least three consecutive blood glucose concentrations ≥2.6 mmol/L, over 12 h, prior to cessation of screening.
The audits examined the records of 400 infants (200 each in 2011 and 2015) to determine guideline adherence. Adherence improved from 2011 to 2015 (59/200 (30%) vs. 95/200 (48%), P < 0.001), with the largest improvement in large-for-gestational age infants (7/50 (14%) vs. 25/50 (50%), P = <0.001). Screened infants whose care was adherent to the guideline had a higher incidence of hypoglycaemia detection (adherent, 64/154 (42%) vs. non-adherent, 34/246 (14%), P < 0.001).
The routine use of calculated birthweight centiles was associated with improved adherence to the neonatal hypoglycaemia guideline and increased detection of neonatal hypoglycaemia in at-risk infants. Thus, identifying practices that improve guideline adherence may improve the detection of hypoglycaemia in asymptomatic at-risk infants.
确定在分娩单元出院前常规使用自动计算的出生体重百分位数是否与提高对新生儿低血糖指南的依从性相关。
我们在新西兰奥克兰的一家三级妇产医院，对在常规使用计算出生体重百分位数之前（2011年）和之后（2015年）随机抽取的有新生儿低血糖风险的新生儿队列，进行了关于对新生儿低血糖指南依从性的回顾性审计。主要结局是对指南的依从性，定义为：（i）出生后48小时内进行血糖浓度筛查；（ii）出生后1 - 2小时进行首次测量；（iii）在停止筛查前12小时内至少有三个连续血糖浓度≥2.6 mmol/L。
审计检查了400名婴儿的记录（2011年和2015年各200名）以确定指南依从性。从2011年到2015年依从性有所提高（59/200（30%）对95/200（48%），P < 0.001），其中大于胎龄儿的改善最为明显（7/50（14%）对25/50（50%），P = <0.001）。遵循指南护理的筛查婴儿低血糖检测发生率更高（遵循，64/154（42%）对不遵循，34/246（14%），P < 0.001）。
常规使用计算出生体重百分位数与提高对新生儿低血糖指南的依从性以及增加对有风险婴儿的新生儿低血糖检测相关。因此，确定能提高指南依从性的做法可能会改善对无症状有风险婴儿低血糖的检测。
