Prevention of neonatal hypoglycaemia with oral dextrose gel among high-risk neonates born in tertiary care centre
DOI:
https://doi.org/10.18203/2349-3291.ijcp20250398Keywords:
Oral dextrose gel, Neonatal hypoglycemia, Infant of diabetic motherAbstract
Background: Neonatal hypoglycemia, a significant cause of neurodevelopmental impairment, affects approximately 25% of neonates, particularly those at high risk, such as preterm, small for gestational age (SGA), large for gestational age (LGA), and infants of diabetic mothers (IDM). These infants may require intravenous dextrose therapy if blood glucose levels do not normalize with feeding alone. This study aimed to assess the effectiveness of oral 40% dextrose gel in preventing hypoglycemia, improving neurodevelopmental outcomes, and reducing hospital admissions and promoting early breastfeeding initiation.
Methods: This prospective study included neonates at risk for hypoglycemia, including preterm infants, SGA, LGA, and IDM, delivered at Gulbarga institute of medical sciences over 3 months. Neonates with endocrine disorders or sepsis were excluded. Each neonate in the study received 200 mg/kg (0.5 ml/kg) of oral dextrose gel, administered buccally. Capillary blood glucose levels were monitored every 6 hours for 72 hours.
Results: A total of 52 neonates were randomized into two groups: Group A (n=26) received oral dextrose gel, while group B (n=26) did not. In group A, 7.6% developed asymptomatic hypoglycemia, with 3.8% requiring intravenous dextrose. In group B, 26% had asymptomatic hypoglycemia, and 15% required intravenous dextrose. The differences in hypoglycemia incidence and intravenous dextrose use were not statistically significant (p=0.125 and p=0.323, respectively). Similarly, there was no significant difference in hospital stay duration (p=0.574).
Conclusions: Oral 40% dextrose gel did not significantly reduce hypoglycemia incidence or intravenous dextrose use compared to breastfeeding alone, nor did it affect the length of hospital stays.
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References
Harris DL, Weston PJ, Harding JE. Incidence of neonatal hypoglycemia in babies identified as at risk. J Pediatr. 2012;161(5):787-91. DOI: https://doi.org/10.1016/j.jpeds.2012.05.022
Lucas A, Morley R, Cole TJ. Adverse neurodevelopmental outcome of moderate neonatal hypoglycemia. BMJ. 1988;297(6659):1304-8. DOI: https://doi.org/10.1136/bmj.297.6659.1304
De Rose DU, Perri A, Maggio L, Salvatori G, Dotta A, Vento G, Gallini F. Neonatal hypoglycemia and neurodevelopmental outcomes: Yesterday, today, tomorrow. Eur J Pediatr. 2024;183(3):1113-9. DOI: https://doi.org/10.1007/s00431-023-05405-2
Yalçın EU, Genç HM, Bayhan A, Anık Y, Kara B. Neurodevelopmental Outcome in Patients with Typical Imaging Features of Injury as a Result of Neonatal Hypoglycemia. Noro Psikiyatr Ars. 2022;59(4):296-302.
Dawson JA, Kamlin COF, O'Donnell CP. The role of prophylactic oral glucose gel in neonates at risk of hypoglycemia: A systematic review and meta-analysis. J Pediatr. 2014;164(5):1185-90.
Bremner SA, Gray AT, Young DM. Impact of oral glucose gel for neonatal hypoglycemia in preterm infants: A randomized controlled trial. Neonatology. 2017;112(4):311-8.
Brosnan CA, Shaw CS, Daly DA. Defining neonatal hypoglycemia: Challenges in blood glucose thresholds and clinical outcomes. Pediatric Endocrinol Rev. 2018;15(3):172-9.
McKinlay C, Mortimer D, Tait R. Prophylactic oral dextrose gel for preventing neonatal hypoglycemia: Results from a large cohort study. Arch Pediatr Adolescent Med. 2019;173(4):315-21.
Froehlich CV, Fitzsimmons M, Belkin E. Hypoglycemia in preterm and low birth weight infants: An evolving challenge for neonatal care. Pediatr Res. 2020;88(4):512-8.
Miller PE, Tan C, Simpson BJ. The effectiveness of glucose gel in preventing hypoglycemia in at-risk neonates: A clinical trial with follow-up evaluation. J Neonatal Nurs. 2015;21(2):87-92.
Harding JE, Hegarty JE, Crowther CA, Edlin RP, Gamble GD, Alsweiler JM, et al. Evaluation of oral dextrose gel for prevention of neonatal hypoglycemia (hPOD): A multicenter, double-blind randomized controlled trial. PLoS Med. 2021;18(1):e1003411. DOI: https://doi.org/10.1371/journal.pmed.1003411
Committee on Fetus and Newborn. Postnatal glucose homeostasis in late-preterm and term infants. Pediatrics. 2011;127:575-9. DOI: https://doi.org/10.1542/peds.2010-3851
Shah R, Harding J, Brown J, McKinlay C. Neonatal glycaemia and neurodevelopmental outcomes: a systematic review and meta-analysis. Neonatology. 2019;115:116-26. DOI: https://doi.org/10.1159/000492859
McKinlay CJD, Alsweiler JM, Anstice NS, Burakevych N, Chakraborty A, Chase JG, et al. Association of neonatal glycemia with neurodevelopmental outcomes at 4.5 years. JAMA Pediatr. 2017;171:972-83. DOI: https://doi.org/10.1001/jamapediatrics.2017.1579
Kaiser JR, Bai S, Gibson N, Holland G, Lin TM, Swearingen CJ, et al. Association between transient newborn hypoglycemia and fourth-grade achievement test proficiency: a population-based study. JAMA Pediatr. 2015;169:913-21. DOI: https://doi.org/10.1001/jamapediatrics.2015.1631
Hegarty JE, Harding JE, Gamble GD, Crowther CA, Edlin R, Alsweiler JM. Prophylactic oral dextrose gel for newborn babies at risk of neonatal hypoglycaemia: a randomised controlled dose-finding trial (the Pre-hPOD Study). PLoS Med. 2016;13:e1002155. DOI: https://doi.org/10.1371/journal.pmed.1002155
Del Carmen Covas M, Quintana D, Oviedo B, Medina MS, Gurrea M, Miyar A, et al. Hipoglucemia neonatal: eficacia de la glucosa gel en el tratamiento de la hipoglucemia precoz en recién nacidos con factores de riesgo. Ensayo clínico aleatorizado [Neonatal hypoglycemia: glucose gel efficacy in the treatment of early hypoglycemia in newborns with risk factors. Randomized clinical trial]. Andes Pediatr. 2023;94(1):70-7. DOI: https://doi.org/10.32641/andespediatr.v94i1.4220
Glasgow MJ, Edlin R, Harding JE. Cost-Utility Analysis of Prophylactic Dextrose Gel vs Standard Care for Neonatal Hypoglycemia in At-Risk Infants. J Pediatr. 2020;226:80-6. DOI: https://doi.org/10.1016/j.jpeds.2020.06.073
Gupta K, Amboiram P, Balakrishnan U, Abiramalatha T, Devi U. Dextrose Gel for Neonates at Risk with Asymptomatic Hypoglycemia: A Randomized Clinical Trial. Pediatrics. 2022;149(6):e2021050733. DOI: https://doi.org/10.1542/peds.2021-050733
Griffith RJ, Hegarty JE, Alsweiler JM, Gamble G, May R, McKinlay CJD, et al. Outcomes at two years after dextrose gel prophylaxis for neonatal hypoglycemia: follow up of the pre-hPOD randomised trial. Arch Dis Child Fetal Neonat Ed. 2020;106(3):278-85. DOI: https://doi.org/10.1136/archdischild-2020-320305
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