Neonatal hypoglycemia nursing decision support system: mixed-methods development and evaluation using interrupted time series

Neonatal hypoglycemia risks irreversible neurological damage, necessitating timely intervention. This study aimed to develop and evaluate a Neonatal Hypoglycemia Nursing Decision Support System (NHNDSS) to enhance clinical decision-making and management of neonatal hypoglycemia. This quasi-experimental study employed an interrupted time series (ITS) design using segmented regression analysis to assess both immediate and long-term impacts of the NHNDSS. Data were collected weekly across 20 time points during both the pre-implementation (June to October 2024, n = 1828) and post-implementation (December 2024 to April 2025, n = 1716) periods. Segmented regression was used to estimate changes in outcome level and trends following system deployment. Key outcomes included hypoglycemia incidence, recurrence, NICU transfers, hospital stay, breastfeeding guidance adherence, and missed glucose monitoring. Additionally, qualitative interviews were conducted with nurses post-implementation to explore their experiences with system usability and integration into clinical workflows. Among 3544 neonates screened, hypoglycemia incidence decreased from 30.14% (551/1828) to 24.94% (428/1716) post-implementation. Initial hypoglycemia incidence significantly declined ( β 3 = -0.014, P < 0.001), while recurrent hypoglycemia initially increased (8.185%) but later showed a downward trend ( β 3 = -0.517, P = 0.003). The average length of hospital stay initially increased but significantly decreased over time ( β 3 = -0.144, P < 0.001). Missed blood glucose (BG) tests were significantly reduced ( β 3 = -0.308, P < 0.001). NICU transfers ( β 3 = -0.149, P = 0.439) and breastfeeding guidance impact ( β 3 = 0.440, P = 0.279) were limited. Nurses acknowledged NHNDSS while suggesting improvements in interoperability and technical functionality. NHNDSS supports evidence-based decision-making, improving neonatal hypoglycemia management and gaining clinical acceptance among nurses.