Small for gestational age (SGA) infants with prolonged hypoglycaemia and high glucose infusion rates ‐ role of early diazoxide therapy

Ian Callander, Jacqueline Stack Liverpool Hospital Background: The “Golden Opportunity” clinical practice improvement (CPI) project was started at Liverpool hospital in 2014 and participates in the NICUS ePREM72 CPI, which focuses on management of Extremely Low Gestational Age Neonates (ELGAN) within the first 72 hours of life. Method: Using translational research and principles of CPI we hold monthly meetings to develop and review a consistent approach to team management of ELGAN. The protocol continues to evolve as each case is individually reviewed and specifies the use of equipment and the role of 2 nurses and 2 doctors with the aim of maximising expertise and efficiency whilst minimising intervention to the baby. Results: During the first 72 hours for babies < 26 weeks 80% of babies are now managed only on CPAP compared to 50% previously; 85% of babies have no umbilical catheters compared to 35% previously; 95% of babies are not given inotropes compared with 80% previously. There is also a trend toward lower rates of death, major IVH, and NEC with no worsening of any other outcomes. Conclusions: Liverpool NICU has been able to dramatically reduce the interventions given to ELGAN without any detriment and indeed have apparently improved short-term stability and outcomes. Although there has been a trend across NSW/ACT toward reduction in interventions, the practice at Liverpool is dramatically different from the other hospitals on benchmarking reports. This presentation outlines the process of the Liverpool “Golden Opportunity” CPI project.