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  • Quality Improvement Article
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Improving timing of early neonatal hypoglycemia screening in the well-baby nursery

Journal of Perinatology volume 46, pages 470–475 (2026)Cite this article

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Abstract

Background

Neonatal hypoglycemia can impair neurodevelopment. Timely glucose screening, aligned with AAP guidelines, may enable prompt detection of hypoglycemia.

Methods

This initiative, conducted from November 2021 to April 2023, aimed to improve the timing of screening without negatively impacting breastfeeding. Key drivers included timely recognition of at-risk status and improved adherence to the institutional protocol.

Results

Overall, 823 infants were screened. Mean age at initial glucose screening decreased by 37%, from 175 to 111 min (p < 0.001). Median (IQR) age at hypoglycemia detection reduced from 133 (107–180) to 101 (81–118) minutes (p < 0.001). Late-detected hypoglycemia episodes (detected >2 h of age) among affected infants decreased from 30 to 0% (p = 0.06). Exclusive breastfeeding and NICU transfer rates for hypoglycemia remained stable.

Conclusions

Early recognition of risk factors, staff education, and improved team handoffs can improve timing of initial hypoglycemia screening without impacting breastfeeding or increasing maternal-infant separation.

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Fig. 1: Pareto chart illustrating identified risk factors among newborns with delayed glucose screening.
Fig. 2: Statistical control X-bar chart of age at initial postnatal blood glucose screening.
Fig. 3: Statistical control P-chart of compliance with the screening component of the hypoglycemia protocol.

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Acknowledgements

We thank the nursing staff in the L&D and MBU units at the University of South Alabama Children’s and Women’s Hospital for their valuable contributions to this initiative.

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Authors and Affiliations

  1. Divisions of Neonatology, University of South Alabama Children’s and Women’s Hospital, Mobile, AL, USA

    Kelechi Ikeri, Manimaran Ramani & Michael Zayek

  2. Divisions of Nursing, University of South Alabama Children’s and Women’s Hospital, Mobile, AL, USA

    Vicki Curtis, Anna Bozeman & Teneshia Edwards

Authors
  1. Kelechi Ikeri
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  2. Vicki Curtis
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  3. Anna Bozeman
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  4. Teneshia Edwards
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  5. Manimaran Ramani
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  6. Michael Zayek
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Contributions

KI conceptualized and designed the initiative, participated in the development and implementation of all phases of the PDSA cycles, led the statistical analysis, developed the control charts and figures, drafted the initial manuscript and reviewed and revised the final manuscript; VC conceptualized and designed the initiative, participated in the development and implementation of all phases of the PDSA cycles, and reviewed the final manuscript; AB and TE participated in the development and implementation of PDSA cycles, and reviewed the final manuscript; MR participated in the development and implementation of the PDSA cycles, reviewed for critical intellectual content and reviewed the final manuscript; MZ conceptualized the initiative, participated in the development and implementation of the PDSA cycles, developed the tables, reviewed for critical intellectual content and revised the final manuscript.

Corresponding author

Correspondence to Kelechi Ikeri.

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The authors declare no competing interests.

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Ikeri, K., Curtis, V., Bozeman, A. et al. Improving timing of early neonatal hypoglycemia screening in the well-baby nursery. J Perinatol 46, 470–475 (2026). https://doi.org/10.1038/s41372-025-02467-y

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