Prevention of Neonatal Hypoglycemia With Oral Glucose Gel for High-Risk Newborns (original) (raw)
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Implementing a Protocol Using Glucose Gel to Treat Neonatal Hypoglycemia
Nursing for women's health
Neonatal hypoglycemia is a leading cause of admission of neonates to the NICU. Typical treatment for neonatal hypoglycemia includes supplementation with formula or, in some cases, intravenous glucose administration. These treatments, though effective at treating hypoglycemia, interrupt exclusive breastfeeding and interfere with mother-infant bonding. Our institution developed a treatment algorithm for newborns at risk for neonatal hypoglycemia. The new algorithm called for the oral administration of 40% glucose gel. This intervention resulted in a 73% decreasein admission rates to the NICU for hypoglycemia, and it supported exclusive breastfeeding, skin-to-skin contact, and mother-infant bonding.
Infant formula is often used as a treatment for neonatal hypoglycaemia in Australia; however, there are concerns that this may jeopardise mother-baby bonding and breastfeeding. Successful use of glucose gel as an alternative treatment for hypoglycaemia has been reported. We wanted to investigate in a pilot study whether the use of glucose gel has the potential to quickly and safely restore normoglycaemia in the infants of diabetic mothers in an Australian setting. Infants with asymptomatic hypoglycaemia were treated with glucose gel (n = 36) and compared to a historical group of infants which had been treated with infant formula (n = 24). Within 15 min of the first treatment, the gel group had a mean blood glucose level (BGL) of 2.6 mmol/L, and 2.7 mmol/L 30 min after the second treatment. This was lower than the BGL after the first treatment for the formula group, which rose to a mean of 2.8 then to 3.2 mmol/L after the second treatment (p = 0.003). In successfully treated infants, administration of the gel resulted in normoglycaemia within 30 min. The likelihood of special care nursery admission was not significantly different between the groups, although we had a small sample size, and our findings should be interpreted with caution. These pilot results provide support for further investigations into the use of glucose gel as an alternative treatment to infant formula.
The Journal of Pediatrics, 2016
Objective: Dextrose gel increasingly is being used as firstline treatment for neonatal hypoglycemia, but longer-term effects are unknown. We determined neurodevelopmental outcome at two years' corrected age in children randomized to treatment with dextrose or placebo gel for hypoglycemia soon after birth (The Sugar Babies Study). Study design: A follow-up study of 184 children who had been hypoglycemic (< 2.6mM) in the first 48 hours and randomized to either dextrose (90/118, 76%) or placebo gel (94/119, 79%). Assessments were undertaken at Kahikatea House, Hamilton, New Zealand, and included neurological function and general health (Pediatrician assessed); cognitive, language, behaviour and motor skills (Bayley-III); executive function (clinical assessment and BRIEF-P); and vision (clinical examination and global motion perception). Co-primary outcomes were neurosensory impairment (cognitive, language or motor score below-1 SD or cerebral palsy or blind or deaf) and processing problem (executive function or global motion perception worse than 1.5 SD from the mean). Statistical tests were two sided with 5% significance level. Results: Mean (SD) birth weight was 3093 (803) g and gestation 37.7 (1.6) weeks. Sixty-six children (36%) had neurosensory impairment (1 severe, 6 moderate, 59 mild) with similar rates in both groups (dextrose 34 (38%) vs. placebo 32 (34%), RR 1.11, 95% CI 0.75-1.63). Processing difficulty was also similar between groups (dextrose 8 (10%) vs. placebo 16 (18%), RR 0.52, 95% CI 0.23-1.15). Conclusions: Dextrose gel is safe for treatment of neonatal hypoglycemia, but neurosensory impairment is common amongst these children.
Italian Journal of Pediatrics
Background Neonatal hypoglycemia is a common disorder especially in at-risk infants and it can be associated with poor long-term neurological outcomes. Several therapeutic interventions are suggested, from the implementation of breastfeeding to the glucose intravenous administration. Oral dextrose gel massaged into the infant’s inner cheek is a recent treatment option of asymptomatic hypoglycemia, after which oral feeding is encouraged. This approach seems to reduce the admission of infants to neonatal intensive care unit (NICU) so favouring maternal bonding and breastfeeding success at discharge. Methods In our ward, we prospectively compared a group of near-term neonates, (Gr2, n = 308) at risk for hypoglycemia, treated with an innovative protocol based on the addition of 40% oral dextrose gel (Destrogel, Orsana®,Italy) administered by massaging gums and cheek with historical matching newborns (Gr1, n = 389) treated with a formerly used protocol, as control group. The primary outc...
Journal of pediatrics review, 2022
Neonatal hypoglycemia is one of the major complications in neonatal wards, requiring rapid diagnosis and treatment to prevent its complications. Dextrose gel is used as a cheap and safe choice. Thus, the present systematic review and meta-analysis study aimed to investigate the effects of oral dextrose gel in preventing and treating neonatal hypoglycemia. To find the relevant articles, the national databases, including Barekat Gostar, SID, Magiran, IranDoc, and international databases, including PubMed, Scopus, Web of Science, Cochrane, and Google Scholar were consulted with standard keywords. The data were analyzed using the STATA 14 software, while the P value < 0.05 was considered significant. In 9 articles with a sample size of 8755 neonates, the mean neonatal weight ranged from 2890 to 3669 g. The share of neonates born through normal vaginal delivery equaled 61%, while 16% had low birth weight (below 2500 g), 16% had high birth weight (above 4500 g), 51% had diabetic mothers, 20% were premature, and 88% were singleton. Oral dextrose gel reduced the risk of neonatal hypoglycemia by OR=0.83 (95% CI: 0.75-0.93). However, neonatal hypoglycemia treatment with oral dextrose gel had an OR=0.78 (95% CI: 0.57-1.07), which was not statistically significant. Oral dextrose gel was effective in preventing neonatal hypoglycemia.
Breastfeeding Medicine, 2021
A central goal of The Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical conditions that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient. Purpose T o provide guidance in the first hours/days of life to: Differentiate transitional neonatal hypoglycemia from persistent pathologic hypoglycemia Prevent clinically significant hypoglycemia in newborn infants Appropriately monitor blood/plasma glucose levels in at-risk term and late preterm neonates Manage clinically significant hypoglycemia in newborn infants to prevent neurologic injury Maximize breast milk provision to babies Establish and preserve maternal milk supply during medically necessary supplementation for hypoglycemia or during separation of mother and baby. About the 2020 Revised Protocol Key research articles before 2014 were retained and more recent information was added from primary studies and compilations. Specific studies were assigned a level of evidence, and Strength of Recommendation Taxonomy (SORT: A, B, C) 1 was used for recommendations. The SORT rating system addresses the three key elements (quality, quantity, and consistency) recommended by the Agency for Healthcare Research and Quality. Levels of evidence are applied after each specific recommendation in brackets, e.g., [A], [B], [C]. Recommendations are updated based on the last 6 years of new information and critical older studies. This clinical protocol is intended to provide practitioners with pragmatic evidence-based guidance to keep infants safe while mini
Italian Journal of Pediatrics, 2018
Background: Continuous glucose monitoring using subcutaneous sensors is useful in the management of glucose control in neonatal intensive care. We evaluated feasibility and reliability of a continuous glucose monitoring system in a population of very low birth weight neonates needing parenteral nutrition. Moreover, we presented percentiles of glycemia of the studied population. Methods: Very low birth weight neonates were enrolled within 24 h from birth. An ENLITE sensor connected to a continuous glucose monitoring system was inserted and maintained for at least 72 h. Data obtained with the continuous glucose monitoring system and with a glucometer were compared. Calibration was performed every 12 h. Results: Twenty-three patients (9 males) were included. Median gestational age was 28 weeks (range 23-30) and median birth weight was 860 g (range 500-1092). A total of 299 paired glucose values were obtained. Modified Clarke Error Grid criteria for clinical significance were met. 74 and 33 episodes of hypoglycemia and hyperglycemia were detected, respectively. 31,329 values of glycemia were analyzed and the percentiles calculated. Conclusions: This continuous glucose monitoring system is safe and accurate. It allows increasing the detection of hypo-and hyper-glycaemia episodes and it could be routinely used in the management of glucose infusion in very low birth weight neonates under total parenteral nutrition.
Incidence of hypoglycemia in newborn infants identified as at risk
The Journal of Maternal-Fetal & Neonatal Medicine, 2019
Background: Temporary low plasma glucose concentrations are common in healthy newborns. Although there is no uniform definition of neonatal hypoglycemia, there is a consensus in the current literature that plasma glucose concentrations should be measured in infants at risk. Known risk groups for transient neonatal hypoglycemia include infants of diabetic mothers (IDM), large (LGA) or small (SGA) for gestational age and late preterm (LPT) infants. Objectives: The aim of this retrospective trial was to determine the incidence of hypoglycemia and the impact of the application of a 2011 revised guideline in respect of additional feeding or i.v. glucose administration, admission to a neonatal ward and the number of blood samples taken. Methods: During the period 1 January 2015 to 31 January 2016, the plasma glucose concentrations of all infants at risk were determined. They were screened over a period of 24 hours or until plasma glucose concentration was >45 mg/dL on three occasions. Hypoglycemia was defined as a plasma glucose concentration <40 mg/dL, regardless of the age of the infant. Results: One hundred and thirty-six (13.6%) out of 1017 newborns were identified as at-risk patients, 119 (87.5%) of whom were included in the final data evaluation. Ten study participants had more than one risk factor and 32 (26.9%) newborns (male:female ¼ 1.1:1) had a total of 40 hypoglycemic episodes. Three (9.4%) out of these 32 newborns had to be transferred to the neonatal ward for i.v. glucose treatment. The mean number of blood samples taken was 7.6 ± 2.4. Conclusions: The incidence of hypoglycemia in the studied infants at risk was 27%, and 19.7 blood samples had to be taken to detect one episode of low glucose concentration. Neonatal hypoglycemia can be recognized and avoided in time, which justifies the establishment of a standardized plasma glucose measurement protocol in newborn infants at risk. BRIEF RATIONALE Following a considerable number of sources, it is recommended that infants at risk be identified, low plasma glucose concentrations prevented and, if necessary, the affected neonates cared for. Our data show that the risk group for neonatal hypoglycemia comprised about one-tenth of all infants at our nursery and hypoglycemia occurred in one-fourth. These results are in accordance with the recommendations to implement this protocol as a screening tool in neonates.
Neonatal Hypoglycemia: Article Review
2020
Introduction: Neonatal hypoglycemia is one of the most common metabolic problems in newborns and id defined as a plasma glucose level of less than 30 mg/dL in the first 24 hours after delivery and further up to 45 mg/dL. It poses a risk of neurological injury, mental retardation, recurrent seizure activity, personality disorders, and developmental delay in newborn babies. In this condition, the newborn should be fed immediately after the delivery as well their blood glucose level should be measured within 2 3 hours, half an hour after the feeding. Despite being one of the common problems after birth, the management of low blood glucose levels remains challenging due to the lack of a definitive approach provided by healthcare professionals. With the establishment of the right definitive approach, both transient and neonatal hypoglycemia can be treated well. There are various treatment options included, such as dextrose infusion, glucagon, glucocorticoids, diazoxide, octreotide, and n...