Introduction An audit on the management of neonatal hyperglycaemia in a tertiary neonatal unit in 2012 revealed that 42% of infants needed more than 72 h of insulin therapy to achieve euglycaemia and similar percentage had high insulin requirements (>0.1 u/kg/hr). Variable insulin release secondary to adsorption in the infusion tubing or insulin resistance was considered the likely mechanism. Iatrogenic hypoglycaemia was seen in a third of infants within hours of stopping insulin infusion, possibly related to residual insulin in the central line. Hence the following changes in practice were recommended- a) pre-infusion priming of intravenous tubings for stable insulin delivery b) earlier upgrading of insulin sliding-scale to help with insulin resistance and c) insulin administration preferably via peripheral route to decrease the risk of iatrogenic hypoglycaemia.
Aims A re-audit was carried out after one year to assess the impact of above changes.
Methods Prospective case notes review of all admitted infants needing insulin for hyperglycaemia between January-June 2013.
Results Twenty-six hyperglycaemic episodes in 19 of the 175 admitted infants were audited. There was 100% compliance with line priming and all but one infant had insulin via peripheral cannula. All were born <28 weeks gestation and all but one were <1 kg at birth. Fifty percent of these episodes occurred within 72 h of birth. In 10 of the 26 episodes (40%), euglycaemia was achieved within 24 h compared to only 16% in the initial audit. Only 7 of the 26 (27%) episodes needed more than 72 h of insulin treatment to achieve euglycaemia compared to 42% in the previous audit. Iatrogenic hypoglycaemia was seen in only 1 episode (4%) as compared to 33% in the initial audit. Eleven of the 26 (42%) infants needed >0.1 u/kg/hour of insulin infusion by upgrading the sliding-scale with no iatrogenic hypoglycaemia in this group.
Conclusions The implementation of line priming with insulin along with early upgrading of sliding-scale led to early achievement of euglycaemia without any adverse effects. We also recommend insulin administration preferably via peripheral cannula to reduce the risk of iatrogenic hypoglycaemia.