Glucose Gel in Infants at Risk for Transitional Neonatal Hypoglycemia

 

 Permissions and Reprints

Abstract

Objective To evaluate whether glucose gel as a supplement to feedings in infants admitted to the newborn nursery at risk for neonatal hypoglycemia (NH) reduces the frequency of transfer to a higher level of care for intravenous dextrose treatment.

Study Design We revised our newborn nursery protocol for management of infants at risk for NH to include use of 40% glucose gel (200 mg/kg). Study population included late preterm, small and large for gestational age infants, and infants of diabetic mothers. We compared outcomes before (4/1/14–3/31/15: Year 1) and after (4/1/15–3/31/16: Year 2) initiation of the revised protocol. Our prospective primary outcome was transfer to the neonatal intensive care unit (NICU) for treatment with a continuous infusion of dextrose.

Results NICU transfer for management of NH fell from 8.1% in Year 1 (34 of 421 at-risk infants screened) to 3.7% in Year 2 (14 of 383 at-risk infants screened). Rate of exclusive breastfeeding increased from 6% in Year 1 to 19% in Year 2. Hospital charges for the study population decreased from 801,276 USD to 387,688 USD in Year 1 and Year 2, respectively.

Conclusion Our study supports the adjunctive use of glucose gel to reduce NICU admissions and total hospitalization expense.

• References

• 1 Srinivasan G, Pildes RS, Cattamanchi G, Voora S, Lilien LD. Plasma glucose values in normal neonates: a new look. J Pediatr 1986; 109 (01) 114-117
  CrossrefPubMedGoogle Scholar
• 2 Heck LJ, Erenberg A. Serum glucose levels in term neonates during the first 48 hours of life. J Pediatr 1987; 110 (01) 119-122
  CrossrefPubMedGoogle Scholar
• 3 Hoseth E, Joergensen A, Ebbesen F, Moeller M. Blood glucose levels in a population of healthy, breast fed, term infants of appropriate size for gestational age. Arch Dis Child Fetal Neonatal Ed 2000; 83 (02) F117-F119
  CrossrefPubMedGoogle Scholar
• 4 Harris DL, Weston PJ, Signal M, Chase JG, Harding JE. Dextrose gel for neonatal hypoglycaemia (the Sugar Babies Study): a randomised, double-blind, placebo-controlled trial. Lancet 2013; 382 (9910): 2077-2083
  CrossrefPubMedGoogle Scholar
• 5 Hay Jr WW, Raju TNK, Higgins RD, Kalhan SC, Devaskar SU. Knowledge gaps and research needs for understanding and treating neonatal hypoglycemia: workshop report from Eunice Kennedy Shriver National Institute of Child Health and Human Development. J Pediatr 2009; 155 (05) 612-617
  CrossrefPubMedGoogle Scholar
• 6 Cornblath M, Hawdon JM, Williams AF. , et al. Controversies regarding definition of neonatal hypoglycemia: suggested operational thresholds. Pediatrics 2000; 105 (05) 1141-1145
  CrossrefPubMedGoogle Scholar
• 7 Adamkin DH. ; Committee on Fetus and Newborn. Postnatal glucose homeostasis in late-preterm and term infants. Pediatrics 2011; 127 (03) 575-579
  CrossrefPubMedGoogle Scholar
• 8 Thornton PS, Stanley CA, De Leon DD. , et al; Pediatric Endocrine Society. Recommendations from the Pediatric Endocrine Society for Evaluation and Management of Persistent Hypoglycemia in Neonates, Infants, and Children. J Pediatr 2015; 167 (02) 238-245
  CrossrefPubMedGoogle Scholar
• 9 Graz B, Dicko M, Willcox ML. , et al. Sublingual sugar for hypoglycaemia in children with severe malaria: a pilot clinical study. Malar J 2008; 7: 242
  CrossrefPubMedGoogle Scholar
• 10 Bourchier D, Weston P, Heron P. Hypostop for neonatal hypoglycaemia. N Z Med J 1992; 105 (926) 22
  PubMedGoogle Scholar
• 11 Brown LD, Rozance PJ. A sweet addition for the treatment of neonatal hypoglycemia. J Pediatr 2016; 170: 10-12
  CrossrefPubMedGoogle Scholar
• 12 Bennett C, Fagan E, Chaharbakhshi E, Zamfirova I, Flicker J. Implementing a protocol using glucose gel to treat neonatal hypoglycemia. Nurs Womens Health 2016; 20 (01) 64-74
  CrossrefPubMedGoogle Scholar
• 13 Weston PJ, Harris DL, Battin M, Brown J, Hegarty JE, Harding JE. Oral dextrose gel for the treatment of hypoglycaemia in newborn infants. Cochrane Database Syst Rev 2016; (05) CD011027
  PubMedGoogle Scholar
• 14 WHO. The World Health Organization's infant feeding recommendation; January 2015. Available at: http://www.who.int/nutrition/topics/infantfeeding_recommendation/en/ . Accessed November 8, 2017
  PubMedGoogle Scholar
• 15 Rozance PJ. Update on neonatal hypoglycemia. Curr Opin Endocrinol Diabetes Obes 2014; 21 (01) 45-50
  CrossrefPubMedGoogle Scholar
• 16 Boluyt N, van Kempen A, Offringa M. Neurodevelopment after neonatal hypoglycemia: a systematic review and design of an optimal future study. Pediatrics 2006; 117 (06) 2231-2243
  CrossrefPubMedGoogle Scholar
• 17 Harris DL, Weston PJ, Harding JE. Incidence of neonatal hypoglycemia in babies identified as at risk. J Pediatr 2012; 161 (05) 787-791
  CrossrefPubMedGoogle Scholar
• 18 Special Care Nursery Admissions. Available at: https://www.marchofdimes.org/peristats/pdfdocs/nicu_summary_final.pdf . Accessed June 29, 2017
  PubMed
• 19 Stanley CA, Baker L. The causes of neonatal hypoglycemia. N Engl J Med 1999; 340 (15) 1200-1201
  CrossrefPubMedGoogle Scholar
• 20 McKinlay CJD, Alsweiler JM, Ansell JM. , et al; CHYLD Study Group. Neonatal glycemia and neurodevelopmental outcomes at 2 years. N Engl J Med 2015; 373 (16) 1507-1518
  CrossrefPubMedGoogle Scholar
• 21 Harris DL, Alsweiler JM, Ansell JM. , et al; Children with Hypoglycaemia and their Later Development (CHYLD) Study Team. Outcome at 2 years after dextrose gel treatment for neonatal hypoglycemia: follow-up of a randomized trial. J Pediatr 2016; 170: 54-59
  CrossrefPubMedGoogle Scholar
• 22 Screening guidelines for newborns at risk for low blood glucose. Paediatr Child Health 2004; 9 (10) 723-740
  CrossrefPubMedGoogle Scholar
• 23 Rawat M, Chandrasekharan P, Turkovich S. , et al. Oral dextrose gel reduces the need for intravenous dextrose therapy in neonatal hypoglycemia. Biomed Hub 2016; 1 (03) 448511
  PubMedGoogle Scholar
• 24 Breast Feeding Report Card United States 2014. Available at: https://www.cdc.gov/breastfeeding/pdf/2014breastfeedingreportcard.pdf . Accessed July 1, 2017
  PubMed
• 25 Harris DL, Gamble GD, Weston PJ, Harding JE. What happens to blood glucose concentrations after oral treatment for neonatal hypoglycemia?. J Pediatr 2017; 190 (July): 136-141
  CrossrefPubMedGoogle Scholar