Dextrose boluses versus burette dextrose infusions in prevention of hypoglycemia among preterms admitted at Mulago Hospital: an open label randomized clinical trial.

Kutamba, Elizabeth; Lubega, Samuel Kiwanuka; Mugalu, J; Ouma, Jew Ochola; Mupere, Ezekial

doi:10.4314/ahs.v14i3.2

Cited by 5 publications

(3 citation statements)

References 5 publications

(4 reference statements)

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“…Neonatal hypoglycemia, defined differently by various authors as random blood sugars ranging from 18 to 72 mg/dl [ 1 – 3 ], is the most common metabolic abnormality in newborns and results in increased morbidity and mortality [ 1 , 4 , 5 ]. The risk of neonatal hypoglycemia is particularly high in preterms, low birth weight neonates, and neonates born to diabetic mothers [ 1 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

Prevalence and factors associated with neonatal hypoglycemia in Northern Uganda: a community-based cross-sectional study

et al. 2020

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Background Neonatal hypoglycemia is the most common endocrine abnormality in children, which is associated with increased morbidity and mortality. The burden and risk factors of neonatal hypoglycemia in rural communities in sub-Saharan Africa are unknown. Objective To determine the prevalence and risk factors for neonatal hypoglycemia in Lira District, Northern Uganda. Methods This was a community-based cross-sectional study, nested in a cluster randomized controlled trial designed to promote health facility births and newborn care practices in Lira District, Northern Uganda. This study recruited neonates born to mothers in the parent study. Random blood glucose was measured using an On Call® Plus glucometer (ACON Laboratories, Inc., 10125 Mesa Road, San Diego, CA, USA). We defined hypoglycemia as a blood glucose of < 47 mg/dl. To determine the factors associated with neonatal hypoglycemia, a multivariable linear regression mixed-effects model was used. Results We examined 1416 participants of mean age 3.1 days (standard deviation (SD) 2.1) and mean weight of 3.2 kg (SD 0.5). The mean neonatal blood glucose level was 81.6 mg/dl (SD 16.8). The prevalence of a blood glucose concentration of < 47 mg/dl was 2.2% (31/1416): 95% CI 1.2%, 3.9%. The risk factors for neonatal hypoglycemia were delayed breastfeeding initiation [adjusted mean difference, − 2.6; 95% CI, − 4.4, − 0.79] and child age of 3 days or less [adjusted mean, − 12.2; 95% CI, − 14.0, − 10.4]. Conclusion The incidence of neonatal hypoglycemia was low in this community and was predicted by delay in initiating breastfeeding and a child age of 3 days or less. We therefore suggest targeted screening and management of neonatal hypoglycemia among neonates before 3 days of age and those who are delayed in the onset of breastfeeding.

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Section: Introductionmentioning

confidence: 99%

Prevalence and factors associated with neonatal hypoglycemia in Northern Uganda: a community-based cross-sectional study

et al. 2020

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“…Other similar settings have used two hourly boluses of intravenous fluid, which is challenging to administer and risks undulating blood pressure and hypoglycaemia. 21 The NCP therefore implemented fluid administration using burettes in six hourly volumes. A simple fluid prescription chart was introduced to aid prescription and administration of fluids and feeds (online supplementary appendix 4 ).…”

Section: Interventionsmentioning

confidence: 99%

Staged implementation of a two-tiered hospital-based neonatal care package in a resource-limited setting in Eastern Uganda

Burgoine

Ikiror²,

Akol³

et al. 2018

BMJ Glob Health

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Neonatal mortality remains a major global challenge. Most neonatal deaths occur in low-income countries, but it is estimated that over two-thirds of these deaths could be prevented if achievable interventions are scaled up. To date, initiatives have focused on community and obstetric interventions, and there has been limited simultaneous drive to improve neonatal care in the health facilities where the sick neonates are being referred. Few data exist on the process of implementing of neonatal care packages and their impact. Evidence-based guidelines for neonatal care in health facilities in low-resource settings and direction on how to achieve these standards of neonatal care are therefore urgently needed. We used the WHO-Recommended Quality of Care Framework to build a strategy for quality improvement of neonatal care in a busy government hospital in Eastern Uganda. Twelve key interventions were designed to improve infrastructure, equipment, protocols and training to provide two levels of neonatal care. We implemented this low-cost, hospital-based neonatal care package over an 18-month period. This data-driven analysis paper illustrates how simple changes in practice, provision of basic equipment and protocols, ongoing training and dedicated neonatal staff can reduce neonatal mortality substantially even without specialist equipment. Neonatal mortality decreased from 48% to 40% (P=0.25) after level 1 care was implemented and dropped further to 21% (P<0.01) with level 2 care. In our experience, a dramatic impact on neonatal mortality can be made through modest and cost-effective interventions. We recommend that stakeholders seeking to improve neonatal care in low-resource settings adopt a similar approach.

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“…Since dextrose infusion pump is not usually handy in poor countries, a group of researchers in Uganda investigated the effect of dextrose infusion though burette, among preterm, as an alternative to dextrose pump concluded that continuous 10% dextrose infusion by burettes reduces the incidence of hypoglycemia by 81% compared to dextrose boluses [53].…”

Section: Hypoglycemiamentioning

confidence: 99%

The First Sixty Minutes in Preterm Neonates’ Life: Predicted Morbidities and Interventions

El-Atawi¹

2018

JPNC

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Preterm neonates are more vulnerable to many diseases and complications than full-term infants as most of their biological systems are still underdeveloped. Fortunately, most of these morbidities are preventable as there are many interventions that could be performed in the first 60 minutes of neonatal life to avoid them and their long-term consequences, thus rightfully defining 'the golden hour'. The objective of this article is to review the potential morbidities that neonates might experience and understand their mechanisms, risk factors and its possible outcomes. We also reviewed the possible actions that could be implemented during the golden hour to prevent these morbidities and investigated their effectiveness. Medline and Cochrane database for systematic review were the main two electronic database that we used to search for studies. Studies pertaining to morbidities, such as hypothermia, hypoglycemia, respiratory distress, intraventricular hemorrhage (IVH), Chronic lung disease (CLD) and retinopathy of prematurity (ROP) have been selected according to their full text accessibility for us. Reports related to possible interventions that could be performed to prevent these morbidities have also been involved that include but not only restricted to drying & head coverings, polyethylene occlusive skin wraps, ambient room temperature, pre-warmed incubator, heated humidified gases, heated mattress and skin-to-skin contact for hypothermia; dextrose infusion pump, dextrose burette and oral dextrose for hypoglycemia; indomethacin, ibuprofen, antithrombin and heparin for IVH; surfactant and CPAP for respiratory distress; controlling oxygen saturation for ROP. Keywords: The First Sixty Minutes in Preterm Neonates' Life: Predicted Morbidities and Interventions 2/8Copyright: ©2018 El-Atawi et al. the relation between severe hypothermia (<32°C) and shortand long-term neurodevelopmental outcomes are required. Moderate hypothermia was found to be associated with severe intraventricular hemorrhage, intraventricular leukomalacia, and necrotizing enterocolitis. Yet, these associations should be analyzed carefully since they were based on studies with a wide confidence interval. More studies with larger sample size are warranted to accurately illustrate these associations [5]. Moreover, hypothermia increases oxygen consumption, thus leading to hypoxia and subsequently pulmonary vasoconstriction which, in turn, declines surfactant production and worsens respiratory distress. The presence of comorbidities with hypothermia increases the fatality rate, so adding a higher category to the severity of hypothermia would represent an effective addition to the WHO classification of the severity of hypothermia [8].Large surface area of neonates in relation to their small body weight makes them more vulnerable to hypothermia than fullterm babies. Preterm neonates have a higher transepidermal water loss than term due to their immature epidermal layer [9]. Their premature vasomotor control which acts as a thermoregulatory mec...

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Dextrose boluses versus burette dextrose infusions in prevention of hypoglycemia among preterms admitted at Mulago Hospital: an open label randomized clinical trial.

Cited by 5 publications

References 5 publications

Prevalence and factors associated with neonatal hypoglycemia in Northern Uganda: a community-based cross-sectional study

Prevalence and factors associated with neonatal hypoglycemia in Northern Uganda: a community-based cross-sectional study

Staged implementation of a two-tiered hospital-based neonatal care package in a resource-limited setting in Eastern Uganda

The First Sixty Minutes in Preterm Neonates’ Life: Predicted Morbidities and Interventions

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