Dextrose Gel for Neonates at Risk With Asymptomatic Hypoglycemia: A Randomized Clinical Trial

Gupta, Kirti; Amboiram, Prakash; Balakrishnan, Umamaheswari; Ashok, C; Abiramalatha, Thangaraj; Devi, Usha

doi:10.1542/peds.2021-050733

Cited by 13 publications

(10 citation statements)

References 43 publications

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“…2 Dextrose gel reduces the need for intravenous fluids in at-risk neonates with asymptomatic hypoglycemia in the first 48 hours of life. 11 Use of buccal dextrose gel also reduced hospital costs for management of NH in the first 48 hours after birth compared with standard care. 12 13 Hegarty et al 1 reported that babies who received any dose of dextrose gel were less likely to develop hypoglycemia than those who received placebo ( p = 0.03).…”

Section: Use Of Oral Dextrose Gel In Nhmentioning

confidence: 99%

Retracted Article: Neonatal Hypoglycemia: Oral Dextrose Gel and Tahneek Practice

Çaksen

2022

Journal of Pediatric Epilepsy

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In this article, we reviewed the use of oral dextrose gel in neonatal hypoglycemia (NH) and examined tahneek practices from past to present to draw attention to the importance of tahneek for newborn infants. NH, a common metabolic problem, is one of the most common causes of neonatal seizures. A universal approach to diagnosis and management of NH is still lacking. Although oral dextrose gel is the recommended first-line treatment for the management of NH, it may cause a hyperinsulinemic response. Date is an essential high-energy food with a low glycemic index. Tahneek, rubbing of chewed date on the soft palate of the neonate immediately after delivery, has been performed for over 1,400 years because it is one of the Prophet Muhammad's (Sallallahu Alayhi Wa Sallam) sunnahs. It has been noted that tahneek may be alternative to dextrose gel for prophylaxis and treatment of NH; however, no clinical study has been published about this subject according to the best of our knowledge. We think that tahneek practice is more effective, and safer option than oral dextrose gel because of low glycemic index of date. We also believe that tahneek practice has many benefits for newborn infants, because dates have antioxidant, antimicrobial, and anti-inflammatory properties. Randomized controlled studies, including large series, should be conducted about effects of tahneek practice on newborns.

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Section: Use Of Oral Dextrose Gel In Nhmentioning

confidence: 99%

Retracted Article: Neonatal Hypoglycemia: Oral Dextrose Gel and Tahneek Practice

Çaksen

2022

Journal of Pediatric Epilepsy

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“…The safety and efficacy of dextrose gel for the treatment of hypoglycemia in newborns more than 35 weeks' gestational age has been extensively reported and dextrose gel has been adopted by many well-baby nurseries leading to a decrease in the rate of the NICU admission for hypoglycemia. [11][12][13] However, data are lacking on the use and safety of dextrose gel in the NICU or infants <35 weeks' gestational age. Fortytwo percent of our respondents would use dextrose gel after NICU admission, with community hospitals with academic affiliation being more likely to use this practice.…”

Section: Discussionmentioning

confidence: 99%

“…Such interventions include the use of dextrose gel or various medications such as diazoxide, glucagon, and glucocorticoids, in addition to the use of intravenous dextrose. The use of dextrose gel as a treatment for asymptomatic newborns with hypoglycemia has been shown to be effective in decreasing the incidence of hypoglycemia, rate of NICU admission and need for intravenous fluids in the first 48 HOL [11][12][13] without increasing the risk of neurosensory impairment, 14 but data about its use in the NICU are lacking. Hyperinsulinism is the most common cause of persistent hypoglycemia in infants after 48 to 72 HOL and it can be transient which is typically stress-induced or more permanent typically associated with one of several possible gene mutations.…”

mentioning

confidence: 99%

Variability in Diagnosis and Management of Hypoglycemia in Neonatal Intensive Care Unit

Dinu,

Hagan,

Rozance

2024

Am J Perinatol

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Objective Hypoglycemia, the most common metabolic derangement in the newborn period remains a contentious issue, not only due to various numerical definitions, but also due to limited therapeutical options which either lack evidence to support their efficacy or are increasingly recognized to lead to adverse reactions in this population. This study aimed to investigate neonatologists' current attitudes in diagnosing and managing transient and persistent hypoglycemia in newborns admitted to the Neonatal Intensive Care Unit (NICU). Methods A web-based electronic survey which included 34 questions and a clinical vignette was sent to U.S. neonatologists. Results There were 246 survey responses with most respondents using local protocols to manage this condition. The median glucose value used as the numerical definition of hypoglycemia in first 48 hours of life (HOL) for symptomatic and asymptomatic term infants and preterm infants was 45 mg/dL (2.5 mmol/L; 25–60 mg/dL; 1.4–3.3 mmol/L), while after 48 HOL the median value was 50 mg/dL (2.8 mmol/L; 30–70 mg/dL; 1.7–3.9 mmol/L). There were various approaches used to manage transient and persistent hypoglycemia that included dextrose gel, increasing caloric content of the feeds using milk fortifiers, using continuous feedings, formula or complex carbohydrates, and use of various medications such as diazoxide, glucocorticoids, and glucagon. Conclusion There is still large variability in current practices related to hypoglycemia. Further research is needed not only to provide evidence to support the values used as a numerical definition for hypoglycemia, but also on the efficacy of current strategies used to manage this condition. Key Points

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“…Several studies have shown that dextrose gel reduces the need for intravenous dextrose, intravenous fluids, admission to neonatal intensive care unit and increases breast feeding. [20][21][22] Edwards et al recently stated that 'oral dextrose gel is probably an effective and safe first-line treatment for infants with neonatal hypoglycaemia in high-income settings'. 23 However, the use of 'prophylactic oral dextrose gel at 1 hour of age compared with placebo showed no significant difference in the risk of neurosensory impairment at 2 years' corrected age'.…”

Section: Research Hypotheses and Aimsmentioning

confidence: 99%

“…We decided to include dextrose gel to the preventive as well as the therapeutic measures of our SOP even though the use of dextrose gel especially as a preventive measure is controversial. Several studies have shown that dextrose gel reduces the need for intravenous dextrose, intravenous fluids, admission to neonatal intensive care unit and increases breast feeding 20–22. Edwards et al recently stated that ‘oral dextrose gel is probably an effective and safe first‐line treatment for infants with neonatal hypoglycaemia in high‐income settings’ 23.…”

Section: Introductionmentioning

confidence: 99%

Protecting against brain damage by improving treatment in neonates with hypoglycaemia: ProBrain-D—a study protocol of a prospective longitudinal study

et al. 2022

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IntroductionAlthough neonatal hypoglycaemia is the most common metabolic problem in neonates, there is no standard guideline for screening. Additionally, treatment of neonatal hypoglycaemia and glucose administration thresholds are discussed controversially. Severe hypoglycaemia can lead to brain damage, but data on the effects of mild hypoglycaemia on neurological development are limited. To our knowledge, this is the first prospective longitudinal cohort study to analyse if the implementation of a new diagnosis and treatment standard for neonatal hypoglycaemia may improve the outcome of neonates at risk for hypoglycaemia, especially concerning neurodevelopment. Furthermore, the acceptance and feasibility of the standard among different professional groups and parents are analysed.Methods and analysisAfter implementation of a structured standard operating procedure (SOP), detailing preventive measures, blood glucose screening and neonatal hypoglycaemia treatment in a tertiary care hospital, 678 neonates ≥35+0 weeks of gestation will be recruited in a monocentric prospective cohort study. For comparison, 139 children born before the implementation of this new SOP, who had risk factors for neonatal hypoglycaemia or qualified for blood glucose measurements are recruited (retrospective cohort). For the primary end point, comparative analyses between and within the prospective and retrospective cohorts will be performed regarding the neurological outcome at 2–2.5 years of age in Bayley Scales of Infant Development. Furthermore, comprehensive clinical data and data on nutrition and developmental milestones are assessed at different time points (6 weeks, 6, 12, 18 and 24 months) in the prospective cohort. Acceptance and feasibility of the new standard are assessed using questionnaires.Ethics and disseminationThe study has been approved by the Ethics Committee of the Medical Faculty of the Heinrich-Heine-University Düsseldorf (20201162). The results of this study will be disseminated through peer-reviewed journals and presented at international conferences.Trial registration numberDRKS00024086.

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Dextrose Gel for Neonates at Risk With Asymptomatic Hypoglycemia: A Randomized Clinical Trial

Cited by 13 publications

References 43 publications

Retracted Article: Neonatal Hypoglycemia: Oral Dextrose Gel and Tahneek Practice

Retracted Article: Neonatal Hypoglycemia: Oral Dextrose Gel and Tahneek Practice

Variability in Diagnosis and Management of Hypoglycemia in Neonatal Intensive Care Unit

Protecting against brain damage by improving treatment in neonates with hypoglycaemia: ProBrain-D—a study protocol of a prospective longitudinal study

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