P1078 - Effect of Donor Breastmilk on Blood Glucose Levels, Exclusive Breastfeeding, and NICU Admission for Asymptomatic Hypoglycemia

Background: Transient hypoglycemia affects up to 30% of newborn deliveries and is associated with significant risk of NICU admission, geographical separation from parents, and interruption of breastfeeding goals. Factors such as skin-to-skin contact and early feeding have been shown to promote successful breastfeeding and decrease NICU admission for neonatal hypoglycemia. While the World Health Organization, the American Academy of Pediatrics, and the National Institutes of Health agree that early breastfeeding is sufficient for otherwise healthy term infants, controversy exists regarding hospital policies for breastfeeding support, formula supplementation, and the use of dextrose gel to promote exclusive breastfeeding and reduce hypoglycemia related complications including NICU admission.

Objective/

Aims: Implement revised supplementation-based neonatal hypoglycemia guidelines incorporating donor breastmilk (DBM) and assess effects on blood glucose levels, NICU admission, and breastfeeding success.

Measures: SMART Aims were to reduce NICU admission for hypoglycemia below 10% and to improve exclusive breastfeeding at discharge to over 50% over 6 months in high-risk screened patients. Additional balancing measures prioritized determination of DBM usage (% utilized; volume used per patient), cost of utilization (cost per birth; per patient utilized), as well as direct feed-to-feed comparison on blood glucose levels.

Methods: Utilizing the IHI Model for Improvement, our center implemented use of shelf stable donor breastmilk as well as modification of an existing neonatal hypoglycemia guideline for newborns greater than and equal to 35-weeks’ gestation. Specific guidelines for DBM utilization were created for candidacy and duration. Statistical process control charts were used to measure changes in quality over time. Mean values for 2018 were utilized for baseline. For infants with hypoglycemic episodes, changes in blood glucose values following treatment were measured.

Results: Upon implementation of DBM in January 2019 and modification of hypoglycemia algorithm in February 2019, data was collected monthly. At 6 months, mean NICU admission rates for hypoglycemia decreased from 17% to 7% for high-risk infants (Fig. 1). Mean exclusive breastfeeding rates increased from 33% to 43% from for high-risk infants (Fig. 2). An average of 24% high-risk infants utilized DBM with an average volume of 50.8 ml/infant. Median cost was $13.73 per patient utilized and $1.71 per birth. In post-hoc analysis, 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).

Conclusions: This is one of the first investigations of the efficacy of DBM for the treatment of neonatal hypoglycemia. Our data suggests that implementation of DBM in a supplementation-based neonatal hypoglycemia algorithm is a cost-effective way to reduce NICU admission for hypoglycemia and support mothers in achieving their breastfeeding goals. Future targets will continue to identify optimal patients for supplementation and reduce cost of utilization.