O0320 Oct.4: 4:35pm - Effect of Donor Breastmilk vs Formula Supplementation on Blood Glucose Levels in Neonates at Risk for Hypoglycemia

Background: Affecting up to 15% of term and late-preterm infants, transient neonatal hypoglycemia (NH) is a common management challenge in the newborn nursery. Though the World Health Organization, the American Academy of Pediatrics, and the National Institutes of Health agree on the nutritional value of early breastfeeding, the volume of breast milk within the first 48 hours following birth is often low and breast milk during this period is high in protein but lower in carbohydrate than mature milk. Similarly, expressed breast milk often has insufficient volume or substrate content for adequate correction of neonatal hypoglycemia. While formula supplementation is a relatively inexpensive treatment for neonatal hypoglycemia, this practice can disrupt the establishment and duration of breastfeeding. Little evidence, however, exists regarding the use of donor breast milk (DBM) for the treatment of neonatal hypoglycemia.

Objective: To study the effects of feeding and supplementation preference on blood glucose concentrations in infants at risk for NH participating in a supplementation driven neonatal hypoglycemia bundle (SD-NHB).

Design/

Methods: We analyzed 184 total infants born in 2019 at a single tertiary hospital following the implementation of a SD-NHB incorporating shelf-stable DBM. All screened at-risk infants received pre-feed (AC) glucose checks and post-intervention glucose checks were obtained for infants who were hypoglycemic (AC blood glucose <45 mg/dL). Hypoglycemic infants were treated according to the SD-NHB and parental preference. Mean change in blood glucose levels following intervention and time to final hypoglycemic episode were measured.

Results: Supplementation of breastfeeding with DBM showed greater increase in blood glucose values compared to breastfeeding alone (+9.6mg/dL, p<0.05) or breastfeeding with formula supplementation (+7.8 mg/dL, p<0.01) (Fig 1). Supplementation of breastfeeding with DBM showed a similar median time to last hypoglycemic episode (9 hours, 12 minutes; 95% confidence interval (CI) 6 hours, 25 minutes to 12 hours, 1 minute) compared to breastfeeding with formula supplementation (8 hours, 6 minutes; 95% CI 5 hours, 22 minutes to 10 hours, 52 minutes) (Fig 2).

Conclusions: Supplementation of breastfeeding with DBM is an effective alternative to formula supplementation for the treatment of neonatal hypoglycemia. Our data also suggests that DBM supplementation is non-inferior to formula supplementation for duration of hypoglycemia as evidenced by time to last hypoglycemic episode. Future efforts will evaluate interstitial glucose monitoring to confirm these conclusions.