8392 Conducting a Gap Analysis to Improve the Management of Infants with Persistent Hypoglycemia Admitted to a Freestanding Children Hospital
Authors: Castro Lina Maria Ayala , Echanove Veronica , Beckett Omar Randall , Granados Andrea , Diaz Alejandro , Carrillo-Iregui Adriana , Llanos-Martinez Adolfo 
Published: October 2024

Disclosure: L.M. Ayala Castro: None. V. Echanove: None. O.R. Beckett: None. A. Granados: None. A. Diaz: None. A. Carrillo-Iregui: None. A. Llanos-Martinez: None.

Background: Effectively diagnosing and treating hypoglycemia disorders in infants is crucial for preventing potential brain damage. The Pediatric Endocrine Society has provided recent guidelines to assist physicians in identifying infants at risk. At our Institution, high-complexity infants are admitted primarily after 48-72 hours of life, placing them at elevated risk for persistent hypoglycemia. To further implement the guidelines, we started by conducting a comprehensive gap analysis, aiming to pinpoint disparities between current practices and guideline recommendations. Methods: We conducted a retrospective chart review of all infants diagnosed with hypoglycemia from September 2021 to March 2023. Data was collected on demographics, hypoglycemia risk factors, labs of critical samples (CS), glucagon challenge test (GCT), fasting safety test (FST), and genetic studies. For infants diagnosed with hyperinsulinism (HI), we analyzed diazoxide (DZX) usage, response, inpatient treatment duration, and documented side effects. A driver diagram was developed with goal of identifying gaps in medical practice to formulate a targeted improvement intervention. Results: Out of 41 newborns diagnosed with hypoglycemia, CS was collected in 22 infants. Risk factors for hypoglycemia included a family history of hypoglycemia, prematurity, infants of diabetic mothers, large/small gestational age, intrauterine growth restriction, perinatal stress, and poor oral intake. CS labs included insulin, Beta Hydroxybutyrate and cortisol in the majority (80%), follow by growth hormone and free fatty acids (60%). ACTH stimulation test was conducted in 36%. GCT was obtained in eight infants. HI was diagnosed in 16 patients (39%), with genetic testing in 14 of them revealing congenital etiology. DZX was administered to 17 infants (including one without HI criteria), all received diuretics and underwent ECHO evaluation for pulmonary hypertension (PH). One infant developed PH, requiring discontinuation. Eleven infants (64%) were discharged home on DZX. Of the19 infants without CS, all had normoglycemia at discharge, and none underwent FST beforehand. Conclusion: Findings indicated significant disparities in current practice as many of the patients diagnosed with hypoglycemia did not have essential labs for an accurate diagnosis. Implementation of clear guidelines for identifying at-risk infants, standardizing comprehensive CS panels, incorporating GCT after lab collection, and conducting FST before discharge will ensure a more precise diagnostic process. Establishing uniform criteria for HI diagnosis, defining optimal timing for DZX initiation, and fine-tuning the assessment of responses and potential side effects, along with selecting appropriate genetic testing, collectively contribute to a cohesive approach to infant care in the NICU and beyond.

Presentation: 6/2/2024