Date of Award

1-1-2023

Degree Type

Dissertation

Degree Name

Doctor of Philosophy in Nursing

Department

Nursing

First Advisor

Susan DeSanto-Madeya

Abstract

A gap in the evidence exists regarding screening of term normal birth weight newborns without identified risk factors for the presence of hypoglycemia. The purpose of this retrospective electronic health record review was to examine factors leading to and results associated with blood glucose screening of term normal birth weight newborns without previously identified risk factors for hypoglycemia.

The specific aims of this study were to: (a) determine if there were statistically significant differences between screened and unscreened full term, normal birth weight newborns without pre-existing identified risk factors for hypoglycemia by: gender, race, delayed cord clamping, skin-to-skin initiation and intention, initiation, and discontinuation of breastfeeding; (b) determine if there were statistically significant differences among the subgroup of screened newborns who met the definition of hypoglycemia defined as blood glucose < 40mg/dl by point of care testing (POCT) evaluating the same variables as in aim a.; and (c) describe the proportion of infants who met criteria for hypoglycemia who were admitted to the neonatal intensive care unit (NICU) compared to hypoglycemic infants not admitted to NICU.

A retrospective electronic healthcare record review of newborns who met the study criteria during July 1, 2020 and December 31, 2020 was conducted. The final sample consisted of 2,661 term normal birth weight newborns who were either screened or not screened for hypoglycemia. The data was abstracted into REDCap and then outputted into a comma delimited file for statistical analysis using Statistical Analysis Software (SAS) v9.4.

Descriptive and inferential statistics were used to describe the sample. Logistic regression was used for analysis of race and chi square analyses was used for gender, delayed cord clamping, skin-to-skin initiation and intention, and intention, initiation and discontinuation of breastfeeding.

Statistically significant differences in gender, race, delayed cord clamping, and breastfeeding discontinuation between the screened and unscreened groups were identified. Males were more likely to be screened (X2=22.36 p<0.0001). Delayed cord clamping was associated with a lower likelihood of being screened (X2=9.46, p=0.002). Among screened newborns breastfeeding was more often discontinued (X2=12.66, p=0.0004) compared to white newborns, Asians had a greater odds of being screened (4.88, 95%CI 1.22-19.61, p=0.03) greater odds of being screened for hypoglycemia. Among the thirty percent of term normal birth weight newborns screened for hypoglycemia only 21.47% were identified as hypoglycemic.

Blood glucose screening impacted a large proportion of newborns without a high yield of diagnosis for hypoglycemia. Furthermore, screened newborns were less likely to continue breastfeeding. Implementation of value-based care with the guidance of the QMNC framework could shift care focused on the identification and treatment of pathology of a few to greater benefit for all recipients of care.

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