Évaluation de l’adhésion au protocole de « prévention, dépistage et prise en charge des hypoglycémies chez le nouveau-né à risque de plus de 35SA » à la maternité du CHU Grenoble Alpes
Bibliographic record
Abstract
Introduction: Neonatal hypoglycemia is a frequent and potentially serious problem in neonatal medicine. It affects 5% to 15% of newborns, and one in two at-risk newborns actually experience hypoglycemia during the first 48 hours of life. The best preventive measure for neonatal hypoglycemia in at-risk newborns is early feeding within the first hour of life, followed by regular risk-adjusted glycemic monitoring. We therefore implemented an update of practices in the maternity department of the Grenoble Alpes University Hospital Center (CHUGA), based on recent French, American, Canadian and British guidelines. Objectives: The study’s main objective was to assess adherence to the new protocol, with a target of 80% adherence, and thus to assess its long-term feasibility in the prevention of neonatal hypoglycemia. Methods: This was a single-center prospective observational study, conducted between September 1, 2021 and March 1, 2022 in the CHUGA. All infants with at least one hypoglycemia risk factor born after 35 weeks’ gestational age (wGA) were included. The primary endpoint was the adherence to protocol, defined by the number of neonates ≥ 35 wGA at risk of hypoglycemia who were fed during the first hour of life and for whom glycemic monitoring was started at 2 hours of life, in accordance with the new protocol. Results: 253 of the 1,295 deliveries were eligible for enrollment and were included (19.5%). 34.8% were small for gestational age, 31.6% were large for gestational age, 20.6% had moderate perinatal asphyxia, and 16.2% were late preterm. 171 neonates at risk of hypoglycemia (67.6%) were able to feed within the first hour of life and had their first blood glucose assessment before the second feed. Hypoglycemia risk factors were not associated with the main endpoint. Forty-five of the at-risk neonates (17.8%) had at least one hypoglycemia reading (< 2.5mmol/L). The mean time to first hypoglycemia episode was at 5.93±9.89 hours, with a mean value of 2.02±0.512 mmol/L. Only 2.4% of newborns at risk of hypoglycemia were transferred for treatment in the neonatology department. Conclusion: Adherence to protocol was 67%, with clinically satisfying protocol application. The healthcare teams integrated the new recommendation successfully. Monitoring of dextrose was well-conducted. Special attention should be paid to early feeding. Organizational criteria should be study to improve early feeding.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.204 | 0.187 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.003 |
| Bibliometrics | 0.003 | 0.003 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.003 | 0.003 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".