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Sep 27 - AWHONN's Block Party
Monday, September 27, 2010
: 10:00 AM
Title: Assessment for Hypoglycemia in Newborns During Transition: A Retrospective Study
Venetian
Audio File
Discipline: Newborn (NB), Advanced Practice (AP)
Learning Objectives:
Submission Description:- Identify recommendations for the performance of glucose monitoring for term newborns during the transition period.
- Describe the implementation sequence of a research study to address a patient practice problem in a clinical environment.
- List implications for nursing practice based on research study findings.
Despite the absence of evidence to support the practice, glucose assessment is performed at regular intervals for every term newborn admitted to the nursery regardless of symptoms. Nursing leadership challenged the existing practice to the pediatric physicians, requesting change and citing literature recommendations for the appropriate for gestational age infant identified to be at minimal risk of hypoglycemia.
Pediatric physicians were resistant to accept the evidenced based literature to revise policy and practice for glucose assessment during transition without evidence that our region’s newborns demonstrate similarity to those in the published literature. While frustrating to the nursing leadership and nursing team members, especially those who have worked in other facilities where newborns appear to be fine with limited glucose screening, this presented an opportunity to introduce nursing research in the health care environment to address a nursing problem to improve care, reduce expense, and reduce trauma to the newborn population.
The literature review included research that supports healthy full-term newborns without clinical signs of hypoglycemia and born after a normal pregnancy and delivery do not require monitoring of glucose concentrations after birth and supports the position that healthy term newborns do not need routine blood glucose monitoring. A report from the American Academy of Pediatrics Committee on Fetus and Newborn (1993) identified there is no evidence that asymptomatic hypoglycemic infants treated with glucose administration have a better short term or long term outcome than infants who receive no treatment. It is recommended that selective testing for hypoglycemia in high-risk infants may be more appropriate.
A retrospective chart review of a 20% randomized sample of the population of newborns admitted to the Newborn Nursery at two facilities for one year was completed using a data collection form developed from the literature. The sample included 301 term newborns. Data elements were operationally defined and interrater reliability between data collectors was validated. IRB approval was obtained.
Statistical analysis of the data demonstrated support that the study newborns replicate those documented in the literature, and thus supports elimination of the practice of unnecessary blood glucose screening in normal newborns during the transition period. Multiple regression analysis demonstrated no statistical significance for initial glucose assessment related to infant weight or gestational age (p=0.656 and p=0.732 respectively). Data assessment for this study brought to light unknown issues with nursing documentation and practice adherence for this population of patients.
Application of the research findings will improve the delivery of care to newborns in the environment where the research was completed through adoption of evidenced based practice that is less invasive, less resource intensive, and limits interruptions in the transitional bonding period for families and their infants. Dissemination of the research findings, including the process of why the research was completed and the learnings obtained by those participating in research, will provide information to the nursing community of the importance of clinical nursing research to change practice to improve the health of newborns in our care.
Pediatric physicians were resistant to accept the evidenced based literature to revise policy and practice for glucose assessment during transition without evidence that our region’s newborns demonstrate similarity to those in the published literature. While frustrating to the nursing leadership and nursing team members, especially those who have worked in other facilities where newborns appear to be fine with limited glucose screening, this presented an opportunity to introduce nursing research in the health care environment to address a nursing problem to improve care, reduce expense, and reduce trauma to the newborn population.
The literature review included research that supports healthy full-term newborns without clinical signs of hypoglycemia and born after a normal pregnancy and delivery do not require monitoring of glucose concentrations after birth and supports the position that healthy term newborns do not need routine blood glucose monitoring. A report from the American Academy of Pediatrics Committee on Fetus and Newborn (1993) identified there is no evidence that asymptomatic hypoglycemic infants treated with glucose administration have a better short term or long term outcome than infants who receive no treatment. It is recommended that selective testing for hypoglycemia in high-risk infants may be more appropriate.
A retrospective chart review of a 20% randomized sample of the population of newborns admitted to the Newborn Nursery at two facilities for one year was completed using a data collection form developed from the literature. The sample included 301 term newborns. Data elements were operationally defined and interrater reliability between data collectors was validated. IRB approval was obtained.
Statistical analysis of the data demonstrated support that the study newborns replicate those documented in the literature, and thus supports elimination of the practice of unnecessary blood glucose screening in normal newborns during the transition period. Multiple regression analysis demonstrated no statistical significance for initial glucose assessment related to infant weight or gestational age (p=0.656 and p=0.732 respectively). Data assessment for this study brought to light unknown issues with nursing documentation and practice adherence for this population of patients.
Application of the research findings will improve the delivery of care to newborns in the environment where the research was completed through adoption of evidenced based practice that is less invasive, less resource intensive, and limits interruptions in the transitional bonding period for families and their infants. Dissemination of the research findings, including the process of why the research was completed and the learnings obtained by those participating in research, will provide information to the nursing community of the importance of clinical nursing research to change practice to improve the health of newborns in our care.
