Abstract

Objectives: To analyze current management of neonatal hypoglycemia and establish a concept map based on testimonials from physicians who use capillary blood glucose tests to guide management.
Methods: This was an observational, descriptive, mixed qualitative and quantitative study. A questionnaire was administered to physicians, seeking to characterize their responses to neonatal hypoglycemia in pregnancy, labor and delivery, and the immediate neonatal period. Data collection was performed with two groups of Brazilian physicians: neonatologists (group GN) and pediatricians (group GP). A Likert-type scale was used to collect responses. The Mann-Whitney test and Fisher’s exact test were used for statistical analysis of continuous and categorical variables respectively. Statistical significance was accepted at 5%. Principal components analysis with varimax rotation and Kaiser normalization was used to verify the structure of question/answer factors in the two groups of professionals. A concept map was constructed using the Cmap Tools Knowledge Kit, version 5.05.01.
Results: Of the 98 questionnaires analyzed, 34.7% were completed by neonatologists (n=34/98) and 65.3% by pediatricians (n=64/98). Mean age in the two groups (GN and GP) was 42.4 years (SD: 11.78; 95% CI: 40.10, 44.88; p=0.597), with a significant difference in age in men (mean=50 years; SD: 10.35; 95% CI: 45.20, 54.90; p<0.001); 79.2% of respondents (n=78/98) were women. Overall, 32.7% of respondents (n=32/98) claimed they did not currently work with neonates. Respondents in GN had completed more postgraduate courses (p=0.38). The two groups responded similarly to all questions. The responses highlighted the importance of values lower than 40 mg/dL in the diagnosis of neonatal hypoglycemia, as well as the indication of intravenous infusion when glucose was below 40 mg/dL in symptomatic neonates. Immediate institution of periodic capillary blood glucose measurement was recommended for the following groups of neonates: those born to diabetic mothers, those with intrauterine growth restriction, small for gestational age, large for gestational age, preterm neonates, septic neonates, and those with birth asphyxia.
Conclusions: Capillary blood glucose is part of routine neonatal management, especially preventive, in light of the possibility of neonatal hypoglycemia. Our findings highlight that, in high-risk gestational groups, the entire neonatal team should be focused on the risk of hypoglycemia. The development of management algorithms based on the use of peripheral blood glucose test strips has contributed to streamlining the management of neonatal hypoglycemia.

Keywords: Hypoglycemia; Newborn; Maps; Practice guideline; Principal components analysis