Aim A departmental audit conducted in 2004 showed poor adherence to the protocol for management of infants at risk of hypoglycaemia on the postnatal ward. A simplified user friendly protocol was introduced in 2005. We present the impact of this new protocol on the number of infants admitted to the neonatal unit with hypoglycaemia. Method Information was obtained retrospectively from admission records. Infants with a diagnosis of hypoglycaemia, admitted from the postnatal ward or labour ward, were included. Information was also recorded on duration of admission. The period audited was the 4 years prior to, and the 4 years following, introduction of the protocol. Results 222 neonates were admitted with hypoglycaemia (2.3% of live births) before introduction of the protocol compared to 78 infants (0.63% of live births) following the introduction. This is a remarkable 72% reduction in the number of hypoglycaemia admissions (p≤0.0001). Total days spent caring for infants with hypoglycaemia on the neonatal unit was reduced from 1609 days to 525 days. Conclusion The dramatic reduction in the number of admissions following the introduction of the protocol has major implications. It helps reduce the cost of caring for these infants and, importantly, helps prevent unnecessary separation of the infant and mother during the crucial bonding period. This audit highlights that a thorough user friendly protocol can help to reduce hypoglycaemia admissions without the need for additional resources such as a transitional care unit.

No abstract

Background NICE jaundice guidance was implemented in our postnatal ward in September 2010 using the Drager JM103 transcutaneous bilirubinometer (TcB). The results of a before and after intervention study are presented. Aims (1) To evaluate TcB for acceptability, staff workload and ease of use. (2) To evaluate the impact on laboratory bilirubin estimations, requirement for phototherapy and admissions for jaundice. Methodology Data was collected from hospital records and bilirubin log over an 18 week period (for 9 weeks pre and 9 weeks post introduction of guidance intervention). A staff satisfaction survey was conducted to evaluate the TcB. Results Of the 586 live babies in the pre NICE period, 32 required laboratory estimation of bilirubin and 12 received phototherapy. Of the 651 babies in the post NICE period, 53 needed transcutaneous bilirubin estimations, 6 required laboratory testing and 2 phototherapy. There were no admissions to the neonatal unit or Paediatric Admissions Unit for jaundice. All junior doctors/ANNPs and 80% of midwifes felt the TcB was safe, easy to use, reduced workload and resulted in earlier discharge. Conclusions and recommendations (1) TcB is well accepted by staff and reduces the need for laboratory bilirubin estimations by 5 fold. (2) NICE guidance reduced the need for phototherapy 6 fold. We postulate that this might be due to better support with breast feeding associated with earlier awareness of jaundice. There was no increase in admissions before or after discharge. Larger studies are recommended to evaluate the impact on kernicterus.

Introduction An audit on the management of neonatal hyperglycaemia in a tertiary neonatal unit in 2012 revealed that 42% of infants needed more than 72 h of insulin therapy to achieve euglycaemia and similar percentage had high insulin requirements (>0.1 u/kg/hr). Variable insulin release secondary to adsorption in the infusion tubing or insulin resistance was considered the likely mechanism. Iatrogenic hypoglycaemia was seen in a third of infants within hours of stopping insulin infusion, possibly related to residual insulin in the central line. Hence the following changes in practice were recommended- a) pre-infusion priming of intravenous tubings for stable insulin delivery b) earlier upgrading of insulin sliding-scale to help with insulin resistance and c) insulin administration preferably via peripheral route to decrease the risk of iatrogenic hypoglycaemia. Aims A re-audit was carried out after one year to assess the impact of above changes. Methods Prospective case notes review of all admitted infants needing insulin for hyperglycaemia between January-June 2013. Results Twenty-six hyperglycaemic episodes in 19 of the 175 admitted infants were audited. There was 100% compliance with line priming and all but one infant had insulin via peripheral cannula. All were born <28 weeks gestation and all but one were <1 kg at birth. Fifty percent of these episodes occurred within 72 h of birth. In 10 of the 26 episodes (40%), euglycaemia was achieved within 24 h compared to only 16% in the initial audit. Only 7 of the 26 (27%) episodes needed more than 72 h of insulin treatment to achieve euglycaemia compared to 42% in the previous audit. Iatrogenic hypoglycaemia was seen in only 1 episode (4%) as compared to 33% in the initial audit. Eleven of the 26 (42%) infants needed >0.1 u/kg/hour of insulin infusion by upgrading the sliding-scale with no iatrogenic hypoglycaemia in this group. Conclusions The implementation of line priming with insulin along with early upgrading of sliding-scale led to early achievement of euglycaemia without any adverse effects. We also recommend insulin administration preferably via peripheral cannula to reduce the risk of iatrogenic hypoglycaemia.

Introduction In spontaneous intestinal perforation (SIP), there is a focal perforation of the gut, with the rest of the bowel appearing normal. Associated factors include prematurity, postnatal steroids and indomethacin. Cases Over 6 years we have encountered three cases of SIP, each occurring in a premature twin. Gestations were 26, 29+4 and 29+6 weeks. Two cases involved a male dichorionic diamniotic twin, the female was a monochorionic diamniotic twin with a diagnosis of twin to twin transfusion syndrome. Antenatally each mother received steroids. Following birth all three babies were intubated, ventilated and given surfactant. Two received trophic feeds of expressed breast milk prior to the diagnosis of SIP. The age at perforation varied between day 2 and day 5. Perforation sites were very similar. At the time of diagnosis all babies were relatively well. Two had been extubated onto CPAP, the other required minimal ventilation. No babies were receiving inotropic support. Full blood count, C reactive protein and blood gas were normal. All underwent bowel surgery and are currently well. Conclusion Our experiences prompted us to investigate whether being a twin was a risk factor for SIP. Despite a detailed literature search we could find no evidence suggesting this. Interestingly, however, there are several reported incidences of SIP occurring in both twins, simultaneously at identical sites. Further research is warranted to investigate if being a twin is a risk factor for SIP.