1. PROPHYLACTIC DEXTROSE GEL DOES NOT PREVENT NEONATAL HYPOGLYCEMIA: A PILOT STUDY
Sarah M. Coors, DO1, PGY-6, Joseph L. Hagan, ScD1, Joshua J. Cousin, MD1, Jeffrey R. Kaiser, MD, MA1
1Texas Children’s Hospital, Division of Neonatology, Baylor College of Medicine
Introduction
(Background and Purpose/objectives)
Results
Transient neonatal hypoglycemia (TNH) is common and may have long-term neurodevelopmental consequences.
The definition of hypoglycemia is debated with limited evidence.
At-risk infants include late preterm (LPT, 35 0/7-36 6/7 weeks), infants of diabetic mothers (IDM), and small or large for gestational age.
40% dextrose gel rubbed into the buccal mucosa has been shown to safely decrease NICU admission for existing TNH and improve breastfeeding.
Many hospitals are instituting protocols using over-the-counter products. Insta-Glucose® is one product with ~77% carbohydrate, yet has not been studied in infants.
The HPOD study showed a single dose of 0.5ml/kg 40% dextrose given prophylactically was effective in decreasing TNH and NICU admission.
We found no difference in the first BG between prophylactic and controls infants on univariate and multivariate analysis.
Additionally, there was no difference in NICU admission for the treatment of TNH with IV dextrose.
Prophylactic
n = 72
Controls
n = 164
P-value
Birthweight (g)
3233 ± 620
3487 ±761
0.019
Gestational age (weeks)
37.9 ± 1.5
38.5 ± 1.7
<0.05
Male (%)
43 (60)
82 (54) NS
Singleton birth (%)
69 (96)
156 (95)
Vaginal birth (%)
39 (54)
99 (61)
Birthweight <10th percentile
6 (8)
16 (10)
Birthweight >90th percentile
7 (10)
50 (30)
<0.001
Abstract
BACKGROUND: Transient neonatal hypoglycemia (TNH) is common. After milk feedings, treatment for asymptomatic TNH is intravenous dextrose; dextrose gel may be an alternative. We hypothesized that prophylactic dextrose gel would reduce TNH and NICU admissions for TNH.
DESIGN/METHODS: This quasi-experimental study allocated asymptomatic at-risk newborns to prophylactic dextrose gel (Insta-Glucose®); others at-risk were controls. Asymptomatic newborns who were late preterm, weighed <2500 or >4000 g, and/or infants of diabetic mothers were included. After the initial feeding, the prophylactic group received dextrose gel (0.5 ml/kg) rubbed into the buccal mucosa, and blood glucose (BG) checked 30 min later.
RESULTS: There were 236 subjects (72 prophylactic, 164 controls). First BG was not different between prophylactic vs control infants (2.9 ± 0.9 mmol/L [52.1 ± 17.1 mg/dL] vs 2.8 ± 0.8 mmol/L [50.5 ± 15.3 mg/dL], P = 0.685) or after adjusting for covariates (P = 0.182). NICU admission for intravenous dextrose for TNH was 9.7% vs 14.6%, respectively (P = 0.403).
CONCLUSION: Prophylactic Insta-Glucose® did not reduce TNH or NICU admissions for TNH. Perhaps the carbohydrate concentration of the gel is high or exogenous dextrose has minimal influence on glucose homeostasis during the first few hours when counterregulatory mechanisms are especially active.
TRIAL REGISTRATION NUMBER: (ClinicalTrials.gov NCT )
Table 1. Subject Characteristics for Prophylactic and Control Groups
Prophylactic
n = 72
Controls
n = 164
P-value
Exclusively breast fed (%)
45 (62.5)
111 (67.68) NS
Age at first feed (min)
Breastfeeding duration (Min)
0.006
Formula volume (ml)
0.013
Time from end of feed to BG (min)
Table 2. Feeding type & duration for Prophylactic and Control Groups * *
Hypotheses
Fig 2. Percent in each risk category. Subjects may be in >1 category. Asterisk (*) indicates significance (P<0.05).
Infants at risk for TNH who receive prophylactic Insta-Glucose® after the first feed will have a higher initial blood glucose (BG) value at 30 minutes and lower incidence of NICU admission for IV dextrose compared to at-risk infants who received feeding alone.
Description of study
Quasi-experimental design at Ben Taub Hospital, Houston
Mothers of at-risk infants were consented prenatally; others at-risk were controls
Included: IDMs, LPT, BW <2500 gm or >4000 gm
Excluded: symptomatic, chromosomal/congenital anomalies, NICU3 admissions, babies who were NPO
Used existing hypoglycemia protocol, gel not used for TNH
Asymptomatic subjects received gel after the first feed
0.5 ml/kg Insta-Glucose® rubbed into the buccal mucosa
BG checked 30 min after gel or feed (enzymatic method)
The Wilcoxon rank-sum test & Fisher’s exact test were used to compare groups in terms of continuous & categorical variables respectively.
Multivariable linear regression was used to compare first BG for the two groups, after adjusting for age at first glucose and at-risk category
Fig 3. Difference in initial BG value was not significant.
Fig 4. Difference in NICU admission was not significant.
Conclusions
Compared to feeding alone, prophylactic dextrose gel did not increase initial glucose values and did not reduce the incidence of TNH or need for NICU admission for IV dextrose.
Varying concentrations of carbohydrate may affect the results and caution should be used.
Perhaps exogenous dextrose has minimal influence on glucose homeostasis during the first few hours and may be tightly regulated by counterregulatory mechanisms.
More evidence is required before prophylactic dextrose gel should be implemented to prevent TNH.
Fig 1. Flow of study procedures.
Funding generously provided by the
Thrasher Early Career Award,
the Texas Pediatric Society Foundation Grant, and the Evangelina “Evie” Whitlock Fellowship Award in Neonatology.
Texas Pediatric Society Electronic Poster Contest