The Sugar Babies Trial – Dextrose gel for neonatal hypoglycaemia

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, which examines the use of dextrose gel in this context.

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

Who did they look at?

Babies born at 35+ weeks of 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

What was the intervention?

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 it into the buccal mucosa and was then followed by a feed (or syringe feed if the baby refused a normal feed)

After 30 mins, if the baby was still hypoglycaemic, the same process was repeated. 

How many patients were included?

There were 514 patients in the ‘ at-risk’ group, and of these, 47% became hypoglycaemic.

What was the measured outcome?

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.

And what did they find?

• 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 the NICU was similar in both groups, but in the dextrose gel group, the reason for admission was less likely to be 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.
• No adverse effects were noted from the dextrose gel.

Bottom line

Giving dextrose gel to treat hypoglycaemia (alongside feeding) is more effective than feeding alone.

It may be worth considering dextrose gel, along with feeding, as first-line management of hypoglycaemia.

Most hypoglycaemia guidelines at the hospitals I have worked at have included feeding as a first-line treatment, and many new guidelines are moving away from hastily aggressive (i.e., IV dextrose boluses) treatment of hypoglycaemia in newborns.