A Graded Approach to Intravenous Dextrose for Neonatal Hypoglycemia Decreases Blood Glucose Variability, Time in the Neonatal Intensive Care Unit, and Cost of Stay

J Pediatr. 2021 Apr;231:74-80. doi: 10.1016/j.jpeds.2020.12.025. Epub 2020 Dec 15.

Abstract

Objective: To determine associations between a graded approach to intravenous (IV) dextrose treatment for neonatal hypoglycemia and changes in blood glucose (BG), length of stay (LOS), and cost of care.

Study design: Retrospective cohort study of 277 infants born at ≥35 weeks of gestation in an urban academic delivery hospital, comparing the change in BG after IV dextrose initiation, neonatal intensive care unit (NICU) LOS, and cost of care in epochs before and after a hospital protocol change. During epoch 1, all infants who needed IV dextrose for hypoglycemia were given a bolus and started on IV dextrose at 60 mL/kg/day. During epoch 2, infants received IV dextrose at 30 or 60 mL/kg/day based on the degree of hypoglycemia. Differences in BG outcomes, LOS, and cost of hospital care between epochs were compared using adjusted median regression.

Results: In epoch 2, the median (IQR) rise in BG after initiating IV dextrose (19 [10, 31] mg/dL) was significantly lower than in epoch 1 (24 [14,37] mg/dL; adjusted β = -6.0 mg/dL, 95% CI -11.2, -0.8). Time to normoglycemia did not differ significantly between epochs. NICU days decreased from a median (IQR) of 4.5 (2.1, 11.0) to 3.0 (1.5, 6.5) (adjusted β = -1.9, 95% CI -3.0, -0.7). Costs associated with NICU hospitalization decreased from a median (IQR) $14 030 ($5847, $30 753) to $8470 ($5650, $19 019) (adjusted β = -$4417, 95% CI -$571, -$8263) after guideline implementation.

Conclusions: A graded approach to IV dextrose was associated with decreased BG lability and length and cost of NICU stay for infants with neonatal hypoglycemia.

Keywords: costs and cost analysis; dextrose; infant; length of NICU stay; neonatal hypoglycemia; newborn.

MeSH terms

  • Administration, Intravenous
  • Biomarkers / blood
  • Blood Glucose / metabolism*
  • Boston
  • Drug Administration Schedule
  • Female
  • Glucose / administration & dosage*
  • Glucose / economics
  • Glucose / therapeutic use
  • Hospital Costs / statistics & numerical data*
  • Humans
  • Hypoglycemia / blood
  • Hypoglycemia / diagnosis
  • Hypoglycemia / drug therapy*
  • Hypoglycemia / economics
  • Infant, Newborn
  • Intensive Care Units, Neonatal / economics
  • Intensive Care Units, Neonatal / statistics & numerical data*
  • Length of Stay / economics
  • Length of Stay / statistics & numerical data*
  • Male
  • Retrospective Studies
  • Sweetening Agents / administration & dosage*
  • Sweetening Agents / economics
  • Sweetening Agents / therapeutic use
  • Treatment Outcome

Substances

  • Biomarkers
  • Blood Glucose
  • Sweetening Agents
  • Glucose