Implementation of dextrose gel in the management of neonatal hypoglycaemia

Ter, Marene; Halibullah, Ikhwan; Leung, Laura; Jacobs, Susan E

doi:10.1111/jpc.13409

Cited by 34 publications

(29 citation statements)

References 12 publications

(17 reference statements)

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“…The follow-up study conducted by the same group questioned the previous promising results by showing that it did not impact neurodevelopmental outcomes (63). Several studies have concluded that oral dextrose gel is suitable to treat hypoglycemia in stable infants, who can be fed (59)(60)(61)(62). Dextrose gel is being favored not only for prevention and treatment of hypoglycemia but for promoting breast feeding and bonding of mothers and babies.…”

Section: Newer Approaches To Management Of Neonatal Hypoglycemiamentioning

confidence: 99%

Hypoglycemia in the preterm neonate: etiopathogenesis, diagnosis, management and long-term outcomes

Sharma¹,

Davis²,

Shekhawat³

2017

Transl. Pediatr

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Glucose, like oxygen, is of fundamental importance for any living being and it is the major energy source for the fetus and the neonate during gestation. The placenta ensures a steady supply of glucose to the fetus, while birth marks a sudden change in substrate delivery and a major change in metabolism. Hypoglycemia is one of the most common pathologies encountered in the neonatal intensive care unit and affects a wide range of neonates. Preterm, small for gestational age (GA) and intra-uterine growth restricted neonates are especially vulnerable due to their lack of metabolic reserves and associated co-morbidities. Nearly 30-60% of these high-risk infants are hypoglycemic and require immediate intervention. Preterm neonates are uniquely predisposed to developing hypoglycemia and its associated complications due to their limited glycogen and fat stores, inability to generate new glucose using gluconeogenesis pathways, have higher metabolic demands due to a relatively larger brain size, and are unable to mount a counter-regulatory response to hypoglycemia. In this review we will discuss the epidemiology; pathophysiology; clinical presentation; management and neurodevelopmental outcomes in affected infants and summarize evidence to develop a rational and scientific approach to this common problem.

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Section: Newer Approaches To Management Of Neonatal Hypoglycemiamentioning

confidence: 99%

Hypoglycemia in the preterm neonate: etiopathogenesis, diagnosis, management and long-term outcomes

Sharma¹,

Davis²,

Shekhawat³

2017

Transl. Pediatr

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“…Treatment of neonatal hypoglycaemia with oral dextrose gel has been shown to result in hypoglycaemia reversal, reduced admission to NICU for hypoglycaemia and reduced formula feeding at 2 weeks of age . Therefore, treatment with dextrose gel has the potential to not only keep mothers and babies together in the first days after birth but also to reduce costs associated with admission to NICU and hypoglycaemia‐associated brain damage . As a result, treatment with dextrose gel is becoming more widespread …”

mentioning

confidence: 99%

“…Therefore, treatment with dextrose gel has the potential to not only keep mothers and babies together in the first days after birth but also to reduce costs associated with admission to NICU and hypoglycaemia‐associated brain damage . As a result, treatment with dextrose gel is becoming more widespread …”

mentioning

confidence: 99%

“…10 As a result, treatment with dextrose gel is becoming more widespread. 9,11 A clinical practice guideline was developed to provide evidence-based recommendations for the use of dextrose gel to treat neonatal hypoglycaemia across New Zealand (NZ). 12 The guideline recommended that babies diagnosed with neonatal hypoglycaemia be treated with 40% oral dextrose gel.…”

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confidence: 99%

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Oral dextrose gel to treat neonatal hypoglycaemia: Clinician survey

Alsweiler

Woodall

Crowther

et al. 2018

J Paediatrics Child Health

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Aims To determine the use of oral dextrose gel to treat neonatal hypoglycaemia in New Zealand (NZ), to identify barriers and enablers to the implementation of the guideline and to determine if there is variation in management between clinical disciplines caring for at‐risk babies. Methods An online survey was distributed to clinicians (including doctors, midwives and nurses) caring for babies with neonatal hypoglycaemia via stakeholders and maternity hospitals. Results A total of 251 clinicians from all 20 District Health Boards (DHBs) completed the survey. Of the responding clinicians, 148 (59%) from 15 (75%) DHBs reported oral dextrose gel use in their hospital, and of these, 129 (87%) reported a local guideline. In 12 of 15 (80%) DHBs, oral dextrose gel could be prescribed by midwives. For a clinical scenario of a baby with neonatal hypoglycaemia, doctors were more likely to prescribe oral dextrose gel than midwives (odds ratio (95% confidence interval), 2.9 (2.2–3.8), P < 0.0001). Of 32 possible combinations of treatment options for this scenario, 31 were selected by one or more clinicians. A guideline was perceived to be the most useful enabler, and availability of oral dextrose gel was seen as the most important barrier. Conclusions Oral dextrose gel is widely used to treat neonatal hypoglycaemia in NZ. Increasing availability of dextrose gel and the clinical practice guideline are likely to further increase the use of oral dextrose gel.

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“…Dextrose gel is now being used in some settings as first-line treatment for neonatal hypoglycemia 12, 13 . However, because the primary objective of treatment of neonatal hypoglycemia is to prevent brain injury, it is important to determine whether treatment with dextrose gel is associated with any beneficial or adverse effects on later development.…”

mentioning

confidence: 99%

Outcome at 2 Years after Dextrose Gel Treatment for Neonatal Hypoglycemia: Follow-Up of a Randomized Trial

Harris

Alsweiler

Ansell

et al. 2016

The Journal of Pediatrics

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Objective To determine neurodevelopmental outcome at two years’ corrected age in children randomized to treatment with dextrose gel or placebo for hypoglycemia soon after birth (The Sugar Babies Study). Study design This was a follow-up study of 184 children who had been hypoglycemic (< 2.6mM [45 mg/dL]) in the first 48 hours and randomized to either dextrose (90/118, 76%) or placebo gel (94/119, 79%). Assessments were performed at Kahikatea House, Hamilton, New Zealand, and included neurological function and general health (Pediatrician assessed), cognitive, language, behaviour and motor skills (Bayley-III), executive function (clinical assessment and BRIEF-P), and vision (clinical examination and global motion perception). Co-primary outcomes were neurosensory impairment (cognitive, language or motor score below −1 SD or cerebral palsy or blind or deaf) and processing difficulty (executive function or global motion perception worse than 1.5 SD from the mean). Statistical tests were two sided with 5% significance level. Results Mean (±SD) birth weight was 3093 ± 803 g and mean gestation was 37.7 ±1.6 weeks. Sixty-six children (36%) had neurosensory impairment (1 severe, 6 moderate, 59 mild) with similar rates in both groups (dextrose 38% vs. placebo 34%, RR 1.11, 95% CI 0.75–1.63). Processing difficulty was also similar between groups (dextrose 10% vs. placebo 18%, RR 0.52, 95% CI 0.23–1.15). Conclusions Dextrose gel is safe for treatment of neonatal hypoglycemia, but neurosensory impairment is common amongst these children.

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Implementation of dextrose gel in the management of neonatal hypoglycaemia

Abstract: Dextrose gel is effective in the management of neonatal hypoglycaemia in the postnatal ward setting, reducing admission to NICU and mother-infant separation.

Cited by 34 publications

References 12 publications

Hypoglycemia in the preterm neonate: etiopathogenesis, diagnosis, management and long-term outcomes

Hypoglycemia in the preterm neonate: etiopathogenesis, diagnosis, management and long-term outcomes

Oral dextrose gel to treat neonatal hypoglycaemia: Clinician survey

Outcome at 2 Years after Dextrose Gel Treatment for Neonatal Hypoglycemia: Follow-Up of a Randomized Trial

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