Inexpensive Dextrose Gel Corrects Hypoglycemia in Newborns

Ricki Lewis, PhD

September 24, 2013

Dextrose gel is a cheap, easy way to correct neonatal hypoglycemia, according to a report published online September 25 in the Lancet.

Neonatal hypoglycemia affects 5% to 15% of otherwise healthy newborns and can impair neural development and cause brain damage. Current practice is extra feedings and frequent blood glucose checks, but some newborns require intravenous glucose administered in an intensive care setting, which interferes with parent–child bonding and the establishment of breast-feeding.

Buccal administration of dextrose gel is one mechanism that people with diabetes use to rapidly counteract a blood glucose plunge, but previous studies have had mixed results in infants. Two small observational studies of babies between 28 and 42 weeks' gestational age reported improvement after dextrose gel treatment, but a study of 75 babies found no effect on blood glucose level and that bottle-fed infants consumed less after administration of the gel.

Therefore, Deborah L. Harris, PhD, from the Waikato District Health Board in Hamilton, New Zealand, and colleagues designed the Sugar Babies Study to assess the efficacy of dextrose gel applied to the inner cheek in addition to feeding to counter hypoglycemia in babies who were considered high risk because of maternal diabetes, preterm birth, or low birth weight.

Between 2008 and 2010, the researchers enrolled 514 at-risk babies from Waikato Women's Hospital within 2 days of birth. All of the infants were born at 35 weeks' gestation or older. Of those, 242 infants (47%) became hypoglycemic and were randomly assigned to receive either 40% dextrose gel or placebo gel for up to 6 doses during a 48-hour period. The study was double-blinded.

Five babies were omitted from analysis as a result of a randomization error. Of the 237 babies included, 118 received dextrose and 119 received placebo. The use of dextrose gel nearly halved the likelihood of treatment failure (blood glucose concentration of less than 2.6 mmol/L 30 minutes after the second of 2 doses of gel) compared with placebo (16 [14%] vs 29 [24%]; relative risk, 0.57; 95% confidence interval, 0.33 - 0.98; P = .04).

The researchers recommend dextrose gel as a first-line treatment for neonatal hypoglycemia for term babies within the first 48 hours. It may be particularly useful in resource-poor countries in which neonatal hypoglycemia is more prevalent. The cost is about $2 per infant.

The study did not assess dose and frequency of administration.

Neil Marlow, MD, from the University College London Elizabeth Garrett Anderson Institute for Women's Health, London, United Kingdom, writes in an accompanying comment that further investigation is needed to evaluate glucose blood levels and requirements in a broader population of newborns. "Such trials can and should be randomised and include outcome evaluations to strengthen our understanding of the association between low blood glucose readings, their timecourse, and neurological outcomes." Until more data are in, he adds, use of dextrose gel should help to minimize the necessity for intravenous glucose.

The trial was funded by the Waikato Medical Research Foundation, the Auckland Medical Research Foundation, the Maurice and Phyllis Paykel Trust, the Health Research Council of New Zealand, and the Rebecca Roberts Scholarship. The researchers and commentator have disclosed no relevant financial relationships.

Lancet. Published online September 25, 2013. Abstract

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