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Blog Archive
- ► 2023 (8)
- ► 2022 (88)
- ► 2021 (54)
Neonatal Hypoglycemia
March 2016
Neonatal hypoglycemia is one of the most common reasons for infant admission to the Neonatal Intensive Care Unit (NICU). Over the past five to ten years, the long-standing guidelines for hypoglycemia and its treatment have been shown to be flawed and not research based. Threshold values relating to pathologic hypoglycemia have not been consistent, and interventions showed a wide range of disparities.
It is known that "fetal glucose levels are dependent on maternal glucose supply and placental transfer, with a low-end normal value of 50 mg/dl. A physiologic decrease in glucose levels normally occurs immediately after birth and continues for the first 2 to 3 hours of life...studies show levels as low as 23 mg/dl in healthy breastfed infants...[and] levels of 30 mg/dl are common in health neonates during the initial 1 to 2 hours of life. After this temporary decrease, glucose levels in healthy neonates soon increase to 40 to 60 mg/dl. The only documented cases of neurological damage have occurred when glucose levels have dropped to low level for many hours" (Bennett, Fagan, Chaharbakhshi, Zamfirova, and Flicker, 2016). The American Academy of Pediatrics (AAP), in 2011, published new management guidelines for intervention at 25 mg/dl, and recommended that the intervention be intravenous glucose for infants with glucose levels of less than 25 mg/dl for more than one hour.
In a newly published study, Bennett et al. discuss the use of 40% glucose gel in the treatment of low neonatal blood sugar levels at their facility. They describe the rationale for using glucose gel, "Oral glucose gel is a longstanding first-line treatment for hypoglycemia in adults and children. Hospital formularies commonly include 40% glucose gel for such purposes. The gel, consisting of 40% glucose, water, and glycerin, is also sold as an over-the-counter medication in most pharmacies. Although glucose gel is commonly used to treat hypoglycemia in children of other age groups, research using glucose gel for treatment of hypoglycemia in neonates is extremely limited. In 2013, Harris et al. published the results of a randomized clinical trial showing the efficacy of the buccal administration of glucose gel to reverse hypoglycemia in neonate with negligible risks. This method of administration was found to be particularly effective because the high vascularization of the mucosa allowed an absorption rate similar to that of IV administration. Their study showed that using 40% glucose gel with feeding was more effective in reversing neonatal hypoglycemia than feeding alone, did not require NICU admission, and was compatible with exclusive breastfeeding. In addition, this treatment was found to be simple to administer, cost effective, well tolerated, and not associated with any adverse effects. Newborns also did not exhibit rebound hypoglycemia but rather exhibited blood glucose levels remaining within normal range" (2016).
The Bennett et al. study included over 1,000 infants during a 14 month time period, an algorithm for glucose gel use, and staff education on risk factors and signs and symptoms of neonatal hypoglycemia. By the end of the study, a 73% reduction in NICU admissions and a reversal of neonatal hypoglycemia in 88% of the identified infants resulted when compared to previous chart reviews with traditional interventions.
The authors discuss the current trend of healthcare in the US as being population-based, decreasing expensive or unnecessary interventions, and continuing to promote the Baby-Friendly guidelines for skin-to-skin, reduced mother-infant separation, and exclusive breastfeeding. They conclude with, "If the use of glucose gel is adopted by other institutions with results similar to ours, we have the potential to revolutionize the standard of treatment through the development of new clinical guidelines for newborns experiencing neonatal hypoglycemia."
Do any of the facilities represented in this forum use the glucose gel protocol? If so, how did you go about bringing the paradigm shift with your caregivers? Please share...perhaps we, too, can help to revolutionize the standard of treatment!!
Kathy
References:
Bennett, C., Fagan, E., Chaharbakhshi, E., Zamfirova, I., and Flicker, J. (2016). Implementing a protocol using glucose gel to treat neonatal hypoglycemia. Nursing for Women's Health, 20(1): 64-74.
Step 2 Education International Inc.
Montreal, Quebec, Canada
H4A 1G2
Courriel
This Privacy Policy describes how your personal information is collected, used, and shared when you visit or make a purchase from https://step2education.com (the "Site").
PERSONAL INFORMATION WE COLLECT
When you visit the Site, we automatically collect certain information about your device, including information about your web browser, IP address, time zone, and some of the cookies that are installed on your device. Additionally, as you browse the Site, we collect information about the individual web pages or products that you view, what websites or search terms referred you to the Site, and information about how you interact with the Site. We refer to this automatically-collected information as Device Information."
We collect Device Information using the following technologies:
- "Cookies" are data files that are placed on your device or computer and often include an anonymous unique identifier. For more information about cookies, and how to disable cookies, visit http://www.allaboutcookies.org.
- "Log files" track actions occurring on the Site, and collect data including your IP address, browser type, Internet service provider, referring/exit pages, and date/time stamps.
- "Web beacons," "tags," and "pixels" are electronic files used to record information about how you browse the Site.
Additionally when you make a purchase or attempt to make a purchase through the Site, we collect certain information from you, including your name, billing address, shipping address, payment information (including credit card numbers), email address, and phone number. We refer to this information as "Order Information."
- Users who are undertaking a course as part of a group or organization have certain data tracked as part of the service we provide to Clients and Facilitators. This includes information showing if you have logged in and when, dates of completion and what and when particular study topics, resources and assessments were viewed and completed. We refer to this information as "Student Access Information"
When we talk about "Personal Information" in this Privacy Policy, we are talking about Device Information, Order Information and Student Access Information.
HOW DO WE USE YOUR PERSONAL INFORMATION?
We use the Order Information that we collect generally to fulfill any orders placed through the Site (including processing your payment information, arranging for shipping, and providing you with invoices and/or order confirmations). Additionally, we use this Order Information to:
- Communicate with you;
- Screen our orders for potential risk or fraud; and
- When in line with the preferences you have shared with us, provide you with information or advertising relating to our products or services.
We use Student Access Information to provide accurate tracking to Users and Clients on completion and use of the courses, as well as for analysis on how to improve our services.
We use the Device Information that we collect to help us screen for potential risk and fraud (in particular, your IP address), and more generally to improve and optimize our Site (for example, by generating analytics about how our customers browse and interact with the Site, and to assess the success of our marketing and advertising campaigns).
SHARING YOUR PERSONAL INFORMATION
We share your Personal Information with third parties to help us use your Personal Information, as described above. For example, with your employer who needs to verify your completion or progress of your studies. We also use Google Analytics to help us understand how our customers use the Site--you can read more about how Google uses your Personal Information here: https://www.google.com/intl/en/policies/privacy/. You can also opt-out of Google Analytics here: https://tools.google.com/dlpage/gaoptout.
Finally, we may also share your Personal Information to comply with applicable laws and regulations, to respond to a subpoena, search warrant or other lawful request for information we receive, or to otherwise protect our rights.
BEHAVIOURAL ADVERTISING
As described above, we use your Personal Information to provide you with targeted advertisements or marketing communications we believe may be of interest to you. For more information about how targeted advertising works, you can visit the Network Advertising Initiative's ("NAI") educational page at https://www.networkadvertising.org/understanding-online-advertising/how-does-it-work.
You can opt out of targeted advertising by:
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Additionally, you can opt out of some of these services by visiting the Digital Advertising Alliance's opt-out portal at: http://optout.aboutads.info.
DO NOT TRACK
Please note that we do not alter our Site's data collection and use practices when we see a Do Not Track signal from your browser.
YOUR RIGHTS
If you are a European resident, you have the right to access personal information we hold about you and to ask that your personal information be corrected, updated, or deleted. If you would like to exercise this right, please contact us through the contact information below.
Additionally, if you are a European resident we note that we are processing your information in order to fulfill contracts we might have with you (for example if you make an order through the Site), or otherwise to pursue our legitimate business interests listed above. Additionally, please note that your information will be transferred outside of Europe, including to Canada and the United States.
DATA RETENTION
When you place an order through the Site, we will maintain your Order Information and Student Access Information for our records unless and until you ask us to delete this information. We are required to keep course completion records for at least 5 years in order to comply with certain accreditation requirements.
CHANGES
We may update this privacy policy from time to time in order to reflect, for example, changes to our practices or for other operational, legal or regulatory reasons.
CONTACT US
For more information about our privacy practices, if you have questions, or if you would like to make a complaint, please contact us by e-mail at [email protected] or by mail using the details provided below:
5890 Monkland Avenue, #16, Montreal, QC, H4A 1G2, Canada
Last Updated: September 2018