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BackgroundNeonatal hypoglycemia is common and a preventable cause of brain damage.Dextrose gel is used to reverse hypoglycemia in diabetics. However, there is little evidence for its use in babies. MethodWe enrolled 514 babies 35 to 42 weeks' gestation, < 48 hours, and at risk of hypoglycemia, to a randomized, double-blind placebo controlled trial to determine whether 40% dextrose gel massaged into the buccal mucosa is more effective than feeding alone in reversing hypoglycemia. Hypoglycemic babies were randomized to 40% dextrose gel 200 mg/kg (n= 118) or placebo (n= 119) and encouraged to feed.Primary outcome was treatment failure (blood glucose concentration <2·6 mmol/L) after two treatment attempts. FindingsDextrose gel reduced the frequency of treatment failure (16/118 (14%) in dextrose vs. 29/119 (24%) in placebo group, RR 0·57; 95% CI 0·33 to 0·98; p=0·04). Babies receiving dextrose gel were less likely to be admitted to intensive care for hypoglycemia, (16/118 (14%) vs. 30/119 (25%); RR 0.54 (0.31, 0.93); P=0.03), to receive formula feeds (median 7 vs. 10 feeds; median difference 2; 95% CI 0 to 4; p=0·04) and to be formula fed at two weeks (5/118 (4%) vs.15/119 (13%), RR 0·34; 95% CI 0·13 to 0·90; p=0·03). 3 InterpretationDextrose gel should be considered for first-line treatment for management of hypoglycemia in late preterm and term babies in the first 48 hours after birth.

Aims/hypothesis Sudden nocturnal death in type 1 diabetes ('dead in bed' syndrome) is thought to be due to ECG QT prolongation with subsequent ventricular tachyarrhythmia in response to nocturnal hypoglycaemia. We investigated this theoretical mechanism using continuous ECG and continuous glucose monitoring in a group of patients with type 1 diabetes. Methods Twenty-five patients with type 1 diabetes (age 20-50 years) underwent two separate 24 h ECG and continuous glucose monitoring periods. Patients were fully ambulant and carried out normal daily activities. Results There were 13 episodes (26% of recordings) of nocturnal hypoglycaemia, eight of <2.2 mmol/l and five of 2.2-3.4 mmol/l. Corrected QT interval (QTc) was longer during nocturnal hypoglycaemia compared with normoglycaemic control periods (445±40 vs 415±23 ms; p=0.037). Cardiac rate and rhythm disturbances (excluding sinus tachycardia) were seen in eight of the 13 nocturnal hypoglycaemia episodes (62%). These were sinus bradycardia (<40 beats/ min; three episodes), ventricular ectopics (three episodes), atrial ectopics (one) and P wave abnormalities (one). Conclusions/interpretation This study demonstrates QTc prolongation and cardiac rate/rhythm disturbances in response to episodes of nocturnal hypoglycaemia in ambulant patients with type 1 diabetes. This may support an arrhythmic basis for the 'dead in bed' syndrome.

Among preterm infants, delayed cord clamping did not result in a lower incidence of the combined outcome of death or major morbidity at 36 weeks of gestation than immediate cord clamping. (Funded by the Australian National Health and Medical Research Council [NHMRC] and the NHMRC Clinical Trials Centre; APTS Australian and New Zealand Clinical Trials Registry number, ACTRN12610000633088 .).

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