Abstract:
Identifying small for gestational age (SGA) and large for gestational age (LGA)
babies is important, because these babies may be at increased risk of hypoglycaemia
at birth. It is proposed that customised birthweight centiles (CBWC) can more
accurately identify these babies by taking into account several physiological
variables of the pregnancy affecting birthweight. These variables are: maternal
height and booking weight, ethnicity, parity, the baby's gender and gestation.
CBWC for a New Zealand (NZ) population were developed by McCowan, Stewart,
Francis and Gardosi (2004), and can be downloaded for free from
www.gestation.net. Using CBWC is not in common practice in NZ, even though its
use was discussed in a 2007 Health and Disability Commissioner report in relation
to neonatal hypoglycaemia. The setting for the study was a NZ District Health
Board (DHB) that calculates a CBWC for each birth. The research question asked
how the evidence behind CBWC was put into practice and what outcomes resulted
from translating this knowledge into action. This was a mixed methods evaluation
which included interviews, focus groups, an audit and document analysis. The
knowledge-to-action (KTA) framework (Straus, Tetroe, & Graham, 2009) was used
as a theoretical template to describe the implementation process that occurred. The
results revealed that maternity care providers were initially challenged by the
evidence. But over time, guideline compliance improved as practitioners
experienced the benefit of using CBWC in practice. All agreed that the CBWC
calculator was user-friendly. However, the audit demonstrated it was easy to make a
mistake or manipulate results when using the calculator. CBWC can help identify
babies at risk of hypoglycaemia who otherwise would have been missed. But it is
unknown what difference it had made in improving neonatal morbidity and
mortality, due to insufficient data. But anecdotally, stakeholders felt it had made a
difference. The findings demonstrated that knowledge translation is a complex
process which is difficult to capture within a one-dimensional framework. However,
using such a framework can identify what stages are needed to complete an
implementation process.
