Oral dextrose gel may cut incidence of neonatal hypoglycaemia

Rubbing dextrose gel inside a newborn baby’s mouth may lower the risk of neonatal hypoglycaemia, a randomised study in PLOS Medicine has found.1

Neonatal hypoglycaemia occurs most frequently in the first 24 hours after birth. It affects as many as 15% of newborn babies and can raise a baby’s risk of brain damage or developmental delay. Babies at the highest risk are born to mothers with diabetes or are delivered preterm or with a small or large birthweight.

Usual management is supplementary feeds with formula milk or admission to the neonatal intensive care unit for more invasive management with intravenous dextrose. Both of these strategies, however, can have detrimental effects on establishing breast feeding. Previous research has shown that dextrose gel can be effective in treating neonatal hypoglycaemia once it develops.

Researchers in New Zealand randomly assigned 416 babies at risk of neonatal hypoglycaemia to receive either a standard (200 mg/kg) or high (400 mg/kg) dose of dextrose gel or a placebo. The gel was massaged into the inside of the baby’s cheek either once within the first hour after birth or four times in the first 12 hours, before feeds.

Babies who received any dose of dextrose gel were less likely to develop hypoglycaemia than those who received placebo (relative risk 0.79 (95% confidence interval 0.64 to 0.98); P=0.03). Of the 277 babies who received any dose of dextrose 114 (41%) developed low blood sugar, compared with 72 of 138 (52%) babies who received placebo. The researchers said that around 10 babies would need to be treated to prevent one baby developing hypoglycaemia.

The study did not find a statistically significant difference between the dosing groups, but the lowest risk of hypoglycaemia was seen in babies who received one dose of 200 mg/kg dextrose (0.68 (0.47 to 0.99); P=0.04). Rates of admission to intensive care were similar in all groups, but admission for hypoglycaemia was less common in babies assigned to receive dextrose gel (0.46 (0.21 to 1.01); P=0.05). Rates of breast feeding and parental satisfaction were similar between all groups, and no babies developed hyperglycaemia.

The study was designed as a dose finding trial, and the researchers are currently carrying out a larger multicentre trial to determine the effect of prophylactic dextrose gel on admission to intensive care units and on long term neurodevelopmental outcomes.

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