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Decreasing early hypoglycemia frequency in at-risk newborns after implementing a new hypoglycemia screening algorithm



Neonatal hypoglycemia may affect long-term neurodevelopment.


Quality improvement (QI) initiative for Mother-Baby-Unit (MBU) admissions (birthweight ≥ 2100 g; ≥35 weeks’ gestation) over two epochs from 2016–2019 to reduce the frequency of early (≤3 h) neonatal hypoglycemia in small and large newborns.


New algorithm using Olsen’s growth curves, hypoglycemia thresholds of <2.22 mmol/L [40 mg/dL] (0–3 h) and <2.61 mmol/L [47 mg/dL] (>3 to 24 h), feeding optimization and 24-hour glucose checks for small for gestational age and preterm newborns.


Among 39,460 newborns, using subsets with identical screening criteria, early hypoglycemia decreased significantly after QI implementation among large for gestational age newborns with birthweight >3850 g (66%) and small for gestational age newborns with birthweight <2500 g (70%). Among all MBU admissions, the adjusted odds of any hypoglycemia in 24 h decreased (P < 0.001).


Feeding optimization may decrease early hypoglycemia frequency in large and small newborns.

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Fig. 1: Flow diagram of newborn groups.
Fig. 2: Percent neonates with any hypoglycemia during the first 3 h postnatal, p control charts.


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We acknowledge the hard work of our MBU staff. We thank Kakkilaya V for help with initial poster control charts and Muraleedharan P for help constructing figures and tables. We thank Jaleel M for his contribution in deciding glucose cutoffs and for manuscript review. We thank Savani RC for reviewing the final manuscript. We thank Gilbert J and Stehel EK for data on breastfeeding in the MBU. Preliminary results were presented as a poster: MS, JS, KJ: “Implementing an Improved Neonatal Hypoglycemia Algorithm” at the Pediatric Academic Societies Meeting, April 2019. An abstract by the current authors was presented as a platform presentation by MS: “Decreasing Early Hypoglycemia Frequency in At-Risk Newborns by Implementing a New Hypoglycemia Screening Algorithm” at the Pediatric Academic Societies Meeting, May 2021.

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All authors reviewed, edited and approved the manuscript as written. MS conceptualized the project, interpreted data and wrote the first draft of the manuscript. MS and KAJ took part in project planning, literature and manuscript review, meetings, logistics, analysis and implementation. KAJ developed the consensus algorithm, provided staff education and supervised implementation. JHS participated in planning, data analysis and interpretation. LSB gave statistical input. PJB compiled NICU data. DBN contributed maternal data. JRK, LPB, SB and NOE participated in the analysis of glucose cutoffs from the Arkansas cohort. LPB participated in building the algorithm and selection of growth curves; he conducted statistical analyses and built the statistical process control charts.

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Correspondence to Muraleedharan Sivarajan.

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Decreasing Early Hypoglycemia Frequency in At-Risk Newborns After Implementing a New Hypoglycemia Screening Algorithm. Supplementary Files.

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Sivarajan, M., Schneider, J.H., Johnson, K.A. et al. Decreasing early hypoglycemia frequency in at-risk newborns after implementing a new hypoglycemia screening algorithm. J Perinatol 41, 2840–2846 (2021).

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