title: Retrospective evaluation of a national guideline to prevent neonatal hypoglycemia.
abstract: Hypoglycemia is common in neonates and may cause adverse neurological outcomes. Guidelines should aim to prevent repeated hypoglycemic episodes in risk groups, but they are not usually stratified according to the severity of hypoglycemia risk, which may lead to inappropriate and redundant interventions. We evaluated the effect of a national prevention guideline stratified according to mild, moderate, and severe risks of hypoglycemia.
  
  
  
  From national registers, a population cohort of 22,725 neonates was identified retrospectively before and after implementation of a national guideline. Of these, 1900 had World Health Organization International Classification of Diseases 10 discharge diagnoses of hypoglycemia. Diagnoses indicating hypoglycemia risk [small/large for gestational age (SGA/LGA), asphyxia, prematurity, maternal insulin-treated diabetes mellitus] were recorded. Neonatal ward files were evaluated to validate hypoglycemia diagnoses. Adjusted odds ratios (aORs) were calculated, adjusting for sex, parity, SGA, LGA, preterm birth, and asphyxia, where relevant.
  
  
  
  Primiparity and male sex were associated independently with hypoglycemia diagnosis [aORs, 1.29 (1.17-1.42) and 1.14 (1.03-1.26), respectively]. Overall incidence of hypoglycemia at discharge decreased from 9.4% to 5.5% after guideline implementation [aORchange, 0.57 (0.50-0.64)]. Overall incidence of validated hypoglycemia decreased from 2.1% to 1.2% [aOR 0.59 (0.46-0.77), p<0.001]. By risk group, the hypoglycemia incidence decreased from 30.5% to 18.6% [aOR 0.52 (0.36-0.75)] among SGA neonates, from 25.8% to 16.4% [aOR 0.57 (0.42-0.76)] among preterm infants, and from 27.4% to 16.6% [aOR 0.63 (0.34-0.83)] among those with asphyxia. LGA neonates showed a decreased incidence in obstetric wards only. No significant change was observed for the diabetes group.
  
  
  
  Stratification of hypoglycemia risk in a hypoglycemia prevention guideline was followed by decreased estimated hypoglycemia incidence, but no causative conclusion could be drawn. Prospective studies with risk stratification for hypoglycemia prevention are encouraged.
authors.affiliation: Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark; Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.
authors.forename: Annett Helleskov
authors.initials: AH
authors.lastname: Rasmussen
authors.affiliation: Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.
authors.forename: Sonja
authors.initials: S
authors.lastname: Wehberg
authors.affiliation: Department of Pediatrics, Lillebaelt Hospital, Kolding, Denmark.
authors.forename: Jesper
authors.initials: J
authors.lastname: Fenger-Groen
authors.affiliation: Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark; Institute of Clinical Research, University of Southern Denmark, Odense, Denmark. Electronic address: henrik.christesen@rsyd.dk.
authors.forename: Henrik Thybo
authors.initials: HT
authors.lastname: Christesen
mesh_terms: D003718:Denmark / Q000453:epidemiology; D005260:Female; D006291:Health Policy; D006801:Humans; D007003:Hypoglycemia / Q000453:epidemiology / Q000517:prevention & control*; D015994:Incidence; D007231:Infant, Newborn; D008297:Male; D017410:Practice Guidelines as Topic; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors
keywords: hypoglycemia; neonate; prevention