Abstract
Introduction/Background
Oral dextrose gel has been shown to be an effective first-line treatment for neonatal hypoglycemia (NH) in full term and late preterm neonates in New Zealand (Harris et al., 2013). The use of dextrose gel in NH has not been evaluated in a Canadian setting. Dextrose gel preparations in Canada are not designed for neonates, and significant variations in dextrose concentration have been reported (Solimano et al., 2019). In October 2018, we instituted a new clinical guideline for the use of dextrose gel to treat NH.
Objectives
Primary Objective: To determine if the use of dextrose gel is effective in treating infants with NH, and if it leads to higher rates of breastfeeding and lower rates of formula supplementation at discharge.
Secondary Objective: To determine if the use of dextrose gel leads to a decrease in NICU admissions due to NH.
Design/Methods
We performed a retrospective cohort study of all neonates treated for hypoglycemia during a six month period before and after implementation of a clinical guideline involving dextrose gel (January 1 – June 30, 2018 and 2019). Equivalent timeframes were used with a two month washout period during guideline implementation.
Results
A total of 269 neonates were treated for hypoglycemia - 109 in the formula group and 160 in the dextrose group. The two study cohorts shared similar baseline characteristics. The timing and severity of the first episode of hypoglycemia were similar in both groups, but the median blood glucose following treatment was higher in the formula group (median 3.3 mmol/L, p<0.05). The proportion of neonates who experienced a second episode of hypoglycemia and the rate of NICU admission for IV dextrose appeared to be higher in the dextrose group, although the differences were not statistically significant. There was no statistical difference in the average volume of formula used per feed at discharge, the rates of exclusive breastfeeding at discharge, or the average quality of breastfeeding as measured by the LATCH score.
Conclusion
This is the first study evaluating dextrose gel in the management of NH in Canada, and it did not identify any significant advantage over formula-based treatment, with some parameters demonstrating an inferior response. With the latest Canadian Paediatric Society hypoglycemia guidelines recommending the routine use of dextrose gel, further studies are urgently needed to evaluate the efficacy of Canadian preparations, and advocacy is needed at a national level to create a paediatric-specific formulation.
Neonatal Hypoglycemia After Antenatal Late Preterm Steroids
