Diabetes in pregnancy: are we providing the best care ... - HQIP

Neonatal care of term babies
12.5.2 Panel assessment of feeding in the neonatal unit
Panels assessed that the type of feed the baby received was appropriate in 62% (26/42) of cases.
12.5.3 Panel assessment of the impact of management in the neonatal care unit on feeding
Panels considered that management of the baby, over and above the fact of being on the neonatal unit
for special care, was likely to have had a negative impact on the establishment of feeding for 38% (15/40)
of all babies (46%, 11/24 when there was a maternal intention to breastfeed and 25%, 4/16 when an
alternative method of feeding was intended (p=0.18) (table 12.6).
Table 12.6
Panel assessment of the impact of management of the baby on establishment of feeding for babies of women with
type 1 and type 2 diabetes on the neonatal unit
Maternal intention to breastfeed
Effect of management of the baby
Yes
n(%)
(N=25)
No
n(%)
(N=17)
Total
n(%)*
(N=42)
Had an impact on establishment of feeding 11 (46) 4 (25) 15 (38)
Did not have an impact on establishment of feeeing 12 (50) 10 (63) 22 (55)
Not enough information 1 (4) 2 (13) 3 (8)
Missing 1 1 2
* Percentages are calculated from all babies in relevant category excluding those babies where data was missing.
12.6 Blood glucose management
The standard agreed for the CEMACH Diabetes Programme (standards accessible at www.cemach.org.uk)
stated that babies of mothers with diabetes should have a test of blood glucose concentration by 4-6 hours
of age, before a feed. 2 The previous descriptive study suggested that blood glucose testing was often
performed too soon, coinciding with the physiological fall in blood glucose after birth and potentially leading
to unnecessary admissions to the neonatal unit. 2
The descriptive study also found that neonatal blood glucose testing was mainly carried out using a
reagent strip technique. 2 Reagent strip testing is unreliable 17 and when considering the diagnosis of
hypoglycaemia, at least one laboratory value should be obtained. 18 The suitability of using a portable
glucose photometer such as the HaemoCue to diagnose neonatal hypoglycaemia is not universally
accepted. 17, 19-21 Currently, national guidelines recommend that the diagnosis of neonatal hypoglycaemia in
babies at increased risk should be made using ward-based glucose electrode or laboratory methods and
not by reagent strip. 2,6
12.6.1 Enquiry fi ndings
12.6.1.1 Timing of first blood glucose testing
Babies had their fi rst blood glucose test mainly during the fi rst two hours of life (table 12.7 ). The fi rst
test was performed at a median of 1.15 hours in babies admitted to a neonatal unit and at a median of
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