Review question: For hypoglycaemic newborn infants, is oral dextrose gel more effective than placebo, no treatment or other active treatments in correcting hypoglycaemia and reducing long-term neurodevelopmental impairment?
Background: Low blood glucose levels in newborn infants are common and occur frequently in certain at-risk groups (infants of diabetic mothers, preterm infants, small and large infants). Infants with low blood glucose levels are at higher risk for developmental problems later in childhood. Therefore, active treatments are generally used to treat these infants, and such treatments frequently require use of formula milk or admission to the neonatal unit, resulting in temporary separation from the mother.
Study characteristics: Two trials to date have assessed use of dextrose gel to reverse low blood glucose levels while the baby remains in the mother's care; these studies included a total of 312 infants. Investigators rubbed dextrose gel into the inside of the infant's cheek; they provided a normal feed for 157 of these infants and placebo gel plus a normal feed, or a normal feed alone, for 155 infants.
Key results: Results suggest that dextrose gel is effective in keeping mothers and infants together and improving the rate of full breast feeding after discharge from hospital. Researchers reported no adverse effects when dextrose gel was given to infants and no effects on development at two years of age.
The review is limited by lack of data for the important outcomes of effectiveness of treatment for individual episodes of low blood glucose levels and effects on brain injury. Further research is required to address these important questions.
Dextrose gel applied to the inside of the cheek is a simple and safe treatment for initial care of infants with low blood glucose levels.
Quality of evidence: Overall the quality of the evidence was moderate to very low. Reasons for downgrading the quality of evidence included imprecision (variation in data), publication bias (evidence based on data from a single trial; one publication in abstract format only), insufficient detail to allow a judgement about risk of bias and/or high levels of disagreement for a particular outcome.
Treatment of infants with neonatal hypoglycaemia with 40% dextrose gel reduces the incidence of mother-infant separation for treatment and increases the likelihood of full breast feeding after discharge compared with placebo gel. No evidence suggests occurrence of adverse effects during the neonatal period or at two years' corrected age. Oral dextrose gel should be considered first-line treatment for infants with neonatal hypoglycaemia.
Neonatal hypoglycaemia, a common condition, can be associated with brain injury. It is frequently managed by providing infants with an alternative source of glucose, given enterally with formula or intravenously with dextrose solution. This often requires that mother and baby are cared for in separate environments and may inhibit breast feeding. Dextrose gel is simple and inexpensive and can be administered directly to the buccal mucosa for rapid correction of hypoglycaemia, in association with continued breast feeding and maternal care.
To assess the effectiveness of dextrose gel in correcting hypoglycaemia and in reducing long-term neurodevelopmental impairment.
We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Web of Science from inception of the database to February 2016. We also searched international clinical trials networks and handsearched proceedings of specific scientific meetings.
Randomised and quasi-randomised studies comparing dextrose gel versus placebo, no treatment or other therapies for treatment of neonatal hypoglycaemia.
Two review authors independently assessed trial quality and extracted data and did not assess publications for which they themselves were study authors.
We included two trials involving 312 infants. No data were available for correction of hypoglycaemia for each hypoglycaemic event. We found no evidence of a difference between dextrose gel and placebo gel for major neurosensory disability at two-year follow-up (risk ratio (RR) 6.27, 95% confidence interval (CI) 0.77 to 51.03; one trial, n = 184; quality of evidence very low). Dextrose gel compared with placebo gel or no gel did not alter the need for intravenous treatment for hypoglycaemia (typical RR 0.78, 95% CI 0.46 to 1.32; two trials, 312 infants; quality of evidence very low). Infants treated with dextrose gel were less likely to be separated from their mothers for treatment of hypoglycaemia (RR 0.54, 95% CI 0.31 to 0.93; one trial, 237 infants; quality of evidence moderate) and were more likely to be exclusively breast fed after discharge (RR 1.10, 95% CI 1.01 to 1.18; one trial, 237 infants; quality of evidence moderate). Estimated rise in blood glucose concentration following dextrose gel was 0.4 mmol/L (95% CI -0.14 to 0.94; one trial, 75 infants). Investigators in one trial reported no adverse outcomes (n = 237 infants).