You are called to the post-natal wards to review an infant of a diabetic mother. He is Day 1 and has a BSL of 2.4. Do you give an IV bolus? Do you feed? What about dextrose gel? We summarise The Sugar Babies Study looking at the use of dextrose gel in this situation.
This paper was published in the Lancet in 2013 – view the abstract here.
Harris DL, Weston PJ, Signal BE, Chase JG, Harding JE, Dextrose gel for neonatal hypoglycaemia (the Sugar Babies Study): a randomised, double-blind, placebo-controlled trial, The Lancet, 2013, 382(9910): 2077-2083.
Babies born at 35+ weeks gestation, who were in the first 48 hours of life, and who were at risk of hypoglycaemia. They were all born in a tertiary hospital in New Zealand.
‘At risk’ included: infants of diabetic mothers;’ preterm; small or large birthweight (i.e. less than 10th centile or over 90th centile); and infants with poor feeding.
BSLs were measured in these babies from one hour after birth, then every 3-4 hours pre-feeds for the first couple of days until hypoglycaemia was or was not detected.
Babies who developed hypoglycaemia (BSL <2.6) were randomised to receive either 3ml of 40% dextrose gel or 3ml of placebo gel (carboxymethyl cellulose). This was administered by rubbing into the buccal mucosa and was then followed by a feed (or syringe feed is the baby refused a normal feed)
After 30 mins, if the baby was still hypoglycaemic, the same process was repeated.
There were 514 patients in the ‘at risk’ group, and of these 47% became hypoglycaemic.
The primary outcome was treatment failure – a BSL of less than 2.6, 30 minutes after the second dose of gel.
Secondary outcomes included: admission to the NICU; feeding frequency; volume of expressed breast milk; need for further dextrose (IV or oral); rebound hypoglycaemia; and time to resolve hypoglycaemia.
- Fewer babies in the dextrose gel group failed treatment.
- Babies in the dextrose gel group were less likely to need extra doses of dextrose.
- Admission rate to NICU were similar in both groups, but the reason for admission in the dextrose gel group was less like to be for hypoglycaemia.
- Giving dextrose gel had no adverse effects on breastfeeding, and in fact babies in this group were more likely to still be breastfeeding at 2 weeks.
- There were no adverse effects noted from the dextrose gel.
What does that mean for us?
This study suggested that giving dextrose gel to treat hypoglycaemia (alongside feeding) is more effective than feeding alone.
Most of the hypoglycaemia guidelines in the hospitals I have worked at have involved feeding as a first-line treatment, and many new guidelines are moving away from being hastily aggressive (i.e. IV dextrose boluses) in their treatmentof hypoglycaemia in newborns.
It may be worth considering dextrose gel along with feeding for first-line management of hypoglycaemia.
It would be interesting to hear other people’s experiences in hospitals of using this….