三级新生儿重症监护病房新生儿低血糖筛查与管理的质量改进举措
A quality improvement initiative for neonatal hypoglycemia screening and management in a level III neonatal intensive care unit.
作者信息
Hulse Whitley N, Schulte Krista, Eickelkamp-Marron Victoria, Redder Hannah, Davidson Jessica M, Chan Belinda, Torr Carrie, DuPont Tara L, Grubb Peter H
机构信息
Division of Neonatology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
Division of Neonatology, Department of Pediatrics, University of Utah Health, Salt Lake City, UT, USA.
出版信息
J Perinatol. 2023 Oct;43(10):1321-1329. doi: 10.1038/s41372-023-01740-2. Epub 2023 Aug 2.
OBJECTIVE
To bring screening and management of neonatal hypoglycemia in alignment with the 2011 AAP hypoglycemia clinical report METHODS: A multidisciplinary team developed a quality improvement initiative for neonatal hypoglycemia in neonates ≥35 weeks gestational age in a Level III neonatal intensive care unit between July 2020 and December 2021. A key driver diagram identified interventions for plan-do-study-act testing with corresponding measures to implement a hypoglycemia management protocol and improve adherence to AAP guidelines.
RESULTS
Time to first blood glucose measurement increased from 49.8 to 122.7 min of life and time to first enteral feed decreased from 14.2 to 3.6 h of life. Neonates receiving intravenous dextrose decreased from 97.1 to 24.7% and discharge rates as a mother-neonate dyad increased from 35 to 62.4%.
CONCLUSIONS
Adherence to the AAP guidelines improved during testing and implementation of a hypoglycemia protocol and was associated with an increased mother-neonate dyad discharge rate.
目的
使新生儿低血糖的筛查与管理符合2011年美国儿科学会（AAP）的低血糖临床报告。方法：一个多学科团队针对2020年7月至2021年12月期间在三级新生儿重症监护病房中胎龄≥35周的新生儿低血糖制定了一项质量改进计划。一个关键驱动因素图确定了用于计划-执行-研究-行动测试的干预措施以及相应的指标，以实施低血糖管理方案并提高对AAP指南的依从性。
结果
首次血糖测量时间从出生后49.8分钟增加到122.7分钟，首次肠内喂养时间从出生后14.2小时减少到3.6小时。接受静脉输注葡萄糖的新生儿比例从97.1%降至24.7%，母婴二元组出院率从35%提高到62.4%。
结论
在低血糖方案的测试和实施过程中，对AAP指南的依从性得到了改善，并且与母婴二元组出院率的提高相关。
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