Oral Dextrose Gel Reduces the Need for Intravenous Dextrose Therapy in Neonatal Hypoglycemia

Abstract

Background: Newborn infants with risk factors may require intravenous (IV) dextrose for asymptomatic hypoglycemia. Administration of IV dextrose and transfer to the neonatal intensive care unit (NICU) may interfere with parent-infant bonding. Objective: To study the effect of implementing dextrose gel supplement with feeds in late preterm/term infants affected by asymptomatic hypoglycemia on reducing IV dextrose therapy. Method: A retrospective study was conducted before and after dextrose gel use: 05/01/2014 to 10/31/2014 and 11/01/2014 to 04/30/2015, respectively. Asymptomatic hypoglycemic (blood glucose level <45 mg/dl) infants in the newborn nursery (NBN) were given a maximum of 3 doses of dextrose gel (200 mg/kg of 40% dextrose) along with feeds. Transfer to the NICU for IV dextrose was considered treatment failure. Results: Dextrose gel with feeds increased the blood glucose level in 184/250 (74%) of asymptomatic hypoglycemic infants compared to 144/248 (58%) with feeds only (p < 0.01). Transfer from the NBN to the NICU for IV dextrose decreased from 35/1,000 to 25/1,000 live births (p < 0.01). Exclusive breastfeeding improved from 19 to 28% (p = 0.03). Conclusions: Use of dextrose gel with feeds reduced the need for IV fluids, avoided separation from the mother and promoted breastfeeding. Neonates who failed dextrose gel therapy were more likely to be large for gestational age, delivered by cesarean section and had lower baseline blood glucose levels.

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

“…They found that oral administration of 40 % glucose gel declines the rate of admission to NICU for hypoglycemia by 73 % and subsequently bypass the abovementioned adverse effects of IV fluid therapy [50]. Another study that involved a maximum of three doses of dextrose gel (200 mg/kg of 40% dextrose) in addition to the feeds of asymptomatic hypoglycemic neonates showed a similar conclusion [51]. A randomized controlled trial was carried out in an effort to optimize the dose of oral dextrose and showed that the incidence of neonatal hypoglycemia can be lessened with a single dose of buccal 40% dextrose gel 200 mg/kg [52].…”

Glucose Gel in Infants at Risk for Transitional Neonatal Hypoglycemia

“…4 A recent report describes that introduction of glucose gel as an adjunctive therapy decreased the frequency of transfer to the NICU for management of NH among other benefits. 23 We report the largest U.S. experience to date with glucose gel as an adjunctive therapy for infants at risk for NH.…”

The effectiveness of oral dextrose gel for the treatment of neonatal hypoglycaemia remains unclear

“…2 4 In addition, a study undertaken by Troughton et al that included 75 infants which used 400 mg/kg of 40% dextrose gel did not find a beneficial effect on recovery from hypoglycaemia at 15 min and 30 min. 5 However, the higher dose of dextrose may have played a role in reducing the volume of the next oral feed in this trial compared with a placebo (7.6±1 mL/kg vs 13.1±1.1 mL/kg).…”