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P16 NEONATAL CARE OF TERM BABIES OF MOTHERS WITH PRE-GESTATIONAL DIABETES IN ENGLAND, WALES AND NORTHERN IRELAND

D. Acolet, presenting, K. Fleming, J. Kovar, R. Houston, J. Hawdon.Confidential Enquiry into Maternal and Child Health, London, UK

Background/Aim: The CEMACH 2005 cohort study of 3808 pregnancies with pre-gestational diabetes found: (a) substandard neonatal management of hypoglycaemia and early feeding; (b) lower intention to breastfeed in mothers with diabetes at birth than in the general population; and (c) higher number than expected admissions of term babies to a neonatal unit. This led to the current enquiry into the care of term babies either admitted to a neonatal unit for special care or remaining with their mother after birth.

Methods:Population: 112 term normally formed babies surviving to 28 days and randomly sampled from the diabetes CEMACH 2005 cohort database. Further comparative analysis into two groups: (a) 42 babies initially admitted to a neonatal unit for special care and (b) 70 babies staying with their mothers. Data collection: Medical records reviewed by independent panels using: (a) structured enquiry pro forma assessing neonatal care provided on labour ward, postnatal ward or neonatal unit and (b) using a series of neonatal national standards (SIGN guidelines, Diabetes NSF, Baby Friendly Initiative).

Results: (1) Avoidable admission to neonatal unit: Enquiry panels assessed that 57% of all neonatal admissions were avoidable, with subsequent care affected for 63% of them (mainly feeding). 29% of admissions occurred because of a unit policy of routinely admitting well babies of mothers with diabetes and another 26% for hypoglycaemia not associated with clinical signs. (2) Barriers to breastfeeding related to: (a) lack of early close maternal contact (not documented in 71% of babies), (b) failure to breastfeed on labour ward (50% of babies admitted to a neonatal unit versus 95% for babies remaining with mothers, p<0.001), (c) 60% of infants received formula as first feed and all …

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