Effects of Intrapartum Administration of Invert Sugar and D5LR on Neonatal Blood Glucose Levels

Abstract

OBJECTIVE:To compare the effects of D5LR and invert sugar administered intrapartum on neonatal blood glucose concentrations. STUDY DESIGN:This is a prospective, randomized, double-blind study. A total of 32 insulin-requiring diabetic patients were randomized to receive either intravenous 10% invert sugar or lactated Ringer's solution with 5% dextrose (D5LR). Regular insulin was given intravenously with an infusion pump to maintain the plasma glucose concentration between 60 and 90 mg/dl. Neonatal blood glucoses were measured at 30 minutes after birth, four times every hour, and thereafter as indicated. Student's t-test was used for continuous variables and Fisher's exact test was used for categorical data. RESULTS:There were no differences in neonatal blood glucose levels, incidence of neonatal hypoglycemia, or length of neonatal hospital stay between the two groups. CONCLUSION:Intrapartum administration of invert sugar is not associated with better neonatal homeostasis of glucose compared with using D5LR. Thus, given the expense of invert sugar, D5LR appears to be preferable for intrapartum control of maternal blood glucose. Journal of Perinatology 2000; 4:217-218.Recently, our group reported on the relative effects of antepartum and intrapartum maternal blood glucose levels on the incidence of neonatal hypoglycemia. 1 We established that intrapartum blood glucose control was a key factor in minimizing the incidence and severity of neonatal hypoglycemia in infants of insulin-requiring diabetic patients.Ten percent invert sugar (mixture of 5% fructose and 5% glucose) was used as the vehicle to provide maternal calories, with insulin given intravenously (i.v.) by continuous infusion to maintain a maternal blood glucose concentration of Ͻ100 mg/dl. 1 Other data 2,3 support the use of fructose solutions to minimize neonatal hypoglycemia.Invert sugar is expensive, and in our institution, indications for its use have been limited to diabetic women during the intrapartum period. Therefore, we elected to conduct a randomized controlled trial to compare the effects of invert sugar and lactated Ringer's solution with 5% dextrose (D5LR) on neonatal blood glucose concentration and incidence of neonatal hypoglycemia. MATERIALS AND METHODSA total of 32 insulin-requiring diabetic patients with single term pregnancies were recruited for participation in the study. Informed consent was obtained. Criteria for induction included Ն38 weeks' gestational age, documented fetal lung maturity, or maternal/fetal indications. The patients were admitted the night before the scheduled induction or elective cesarean section and were then randomized to receive either an i.v. solution of 10% invert sugar or D5LR at a rate of 125 ml/hour. Randomization was done with the use of a computergenerated random-number table. The solution was blinded to both the obstetrician and the pediatrician evaluating the neonate. In addition to the i.v. solution, regular insulin was administered i.v. with an infusion pump at a rate of 1 to 4 U/hour to maintain th...

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