Oral Dextrose Gel Reduces the Need for Intravenous Dextrose Therapy in Neonatal Hypoglycemia

Area of Science:

• Neonatal Medicine
• Pediatric Endocrinology
• Clinical Nutrition

Background:

• Newborn infants at risk for asymptomatic hypoglycemia often require intravenous (IV) dextrose.
• IV dextrose administration and neonatal intensive care unit (NICU) transfer can disrupt crucial parent-infant bonding.
• Alternative, less invasive treatments are needed to manage neonatal hypoglycemia.

Purpose of the Study:

• To evaluate the efficacy of dextrose gel supplementation with feeds in late preterm/term infants with asymptomatic hypoglycemia.
• To determine if dextrose gel reduces the requirement for IV dextrose therapy.
• To assess the impact of dextrose gel on NICU admissions and breastfeeding rates.

Main Methods:

• A retrospective study compared outcomes before and after implementing dextrose gel use (May 2014 - April 2015).
• Asymptomatic hypoglycemic infants (blood glucose <45 mg/dl) received up to 3 doses of dextrose gel (200 mg/kg) with feeds.
• Treatment failure was defined as transfer to the NICU for IV dextrose.

Main Results:

• Dextrose gel increased blood glucose levels in 74% of infants, compared to 58% with feeds alone (p < 0.01).
• Transfer to the NICU for IV dextrose decreased significantly, from 35 to 25 per 1,000 live births (p < 0.01).
• Exclusive breastfeeding rates improved from 19% to 28% (p = 0.03).

Conclusions:

• Dextrose gel supplementation is an effective strategy to reduce IV dextrose use in newborns with asymptomatic hypoglycemia.
• This intervention minimizes separation from mothers, facilitates parent-infant bonding, and supports breastfeeding.
• Infants requiring IV dextrose despite gel therapy were more likely to be large for gestational age, born via C-section, and have lower initial blood glucose levels.