SAT-232 Improving the Management of Infants with Persistent Hypoglycemia Admitted to a Freestanding Children Hospital

Abstract Disclosure: S.L. Echeverri: None. D. Morales: None. M. Diaz-Barbosa: None. C. Valdes: None. S. Hussein: None. A. Granados: None. O.R. Beckett: None. A. Diaz: None. A. Carrillo: None. A. Llanos: None. Background: Effectively diagnosing and treating hypoglycemia disorders in infants is crucial to prevent brain damage. The Pediatric Endocrine Society has developed guidelines to aid physicians in identifying at-risk infants. As a freestanding children's hospital, our institution primarily admits high-complexity infants after 48-72 hours of life, who are at highest risk for persistent hypoglycemia. In March 2023, we initiated a quality improvement (QI) project to enhance the management of patients with persistent hypoglycemia. The objective of this quality improvement (QI) project was to identify and address disparities between current practices and established guideline recommendations to enhance the management of infants with persistent hypoglycemia. Methods: Using Plan-Do-Study-Act (PDSA) cycles, we reviewed medical records of 19 infants admitted with persistent hypoglycemia, from January 2022 to March 2023, focusing on those unable to maintain POC blood glucose >70 mg/dL, identifying gaps such as inconsistent critical sample (CS) collection, limited glucagon stimulation testing, and variability in genetic evaluations and discharge protocols. Interventions included standardizing diagnostic processes, focusing genetic testing on the Invitae Hypoglycemia Panel, and implementing fasting safety tests (FST) for discharge readiness. Post-intervention data (March 2023 to June 2024) showed significant improvements. CS completion rates increased, genetic testing became more selective (reduced from 87.5% to 50%), and moderate progress was observed in ECHO completion (55% to 67%) and FST completion (72% to 75%). Interventions were refined to ensure sustainability and compliance. Results Pre-Intervention Analysis • Of 19 infants, 16 received diazoxide. Significant gaps in CS completion, glucagon stimulation testing, and genetic testing adherence were identified. Post-Intervention Findings • Improved CS Completion: CS panel completion rates increased. • Selective Genetic Testing: Genetic evaluations for infants with suspected HI on DZX decreased from 14/16 (87.5%) to 6/12 (50%). • ECHO and FST Completion: Moderate improvement was observed, with ECHO completion rising from 55% to 67% and FST from 72% to 75%. Conclusion: The QI project improved CS completion and reduced unnecessary genetic testing by standardizing the use of the Invitae Hypoglycemia Panel. Although glucagon stimulation testing showed limited improvement, progress in ECHO and FST completion rates highlights the need for continued efforts to optimize care for infants with persistent hypoglycemia. Presentation: Saturday, July 12, 2025