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Dextrose gel prophylaxis for neonatal hypoglycaemia and neurocognitive function at early school age: a randomised
Xingyu Wei1, Nike Franke1, Jane M Alsweiler2
1Liggins Institute, The University of Auckland, Auckland, New Zealand, Auckland, New Zealand.
Insights
Prophylactic dextrose gel for newborns did not prevent neurocognitive impairment at school age. However, it showed potential benefits in improving motor skills and cognitive scores in children at risk for neonatal hypoglycemia.
Area of Science:
- Neonatal medicine
- Developmental pediatrics
- Public health
Background:
- Neonatal hypoglycemia is a common concern in at-risk infants.
- Early intervention strategies are crucial for long-term neurodevelopmental outcomes.
- The efficacy of prophylactic dextrose gel in preventing neurocognitive impairment requires further investigation.
Purpose of the Study:
- To assess the long-term effects of different doses of prophylactic dextrose gel on neurocognitive function and health.
- To evaluate the impact of dextrose gel on motor skills, cognitive abilities, and cardiometabolic health at 6-7 years of age.
- To determine if early dextrose gel administration influences neurocognitive impairment rates in at-risk children.
Main Methods:
- Early school-age follow-up of the pre-hPOD randomized controlled trial.
- Involved children born at ≥35 weeks gestation with risk factors for neonatal hypoglycemia.
- Assessed neurocognitive function using Toolbox cognitive and motor batteries, with primary outcome as neurocognitive impairment.
Main Results:
- No significant difference in neurocognitive impairment rates between dextrose gel groups and placebo.
- Children receiving dextrose gel showed a reduced risk of motor impairment compared to placebo (3% vs. 14%).
- Dextrose gel exposure was associated with higher mean cognitive scores (106.0 vs. 101.1).
Conclusions:
- Prophylactic neonatal dextrose gel did not alter neurocognitive impairment at early school age.
- Dextrose gel may offer benefits for motor and cognitive development in at-risk children.
- Further school-age follow-up studies are warranted to confirm these findings.
Objective:
To investigate the effect of different doses of prophylactic dextrose gel on neurocognitive function and health at 6-7 years.
Design:
Early school-age follow-up of the pre-hPOD (hypoglycaemia Prevention with Oral Dextrose) study.
Setting:
Schools and communities.
Patients:
Children born at ≥35 weeks with ≥1 risk factor for neonatal hypoglycaemia: maternal diabetes, small or large for gestational age, or late preterm.
Interventions:
Four interventions commencing at 1 hour of age: dextrose gel (40%) 200 mg/kg; 400 mg/kg; 200 mg/kg and 200 mg/kg repeated before three feeds (800 mg/kg); 400 mg/kg and 200 mg/kg before three feeds (1000 mg/kg); compared with equivolume placebo (combined for analysis).
Main Outcomes Measures:
Toolbox cognitive and motor batteries, as well as tests of motion perception, numeracy and cardiometabolic health, were used. The primary outcome was neurocognitive impairment, defined as a standard score of more than 1 SD below the age-corrected mean on one or more Toolbox tests.
Findings:
Of 392 eligible children, 309 were assessed for the primary outcome. There were no significant differences in the rate of neurocognitive impairment between those randomised to placebo (56%) and dextrose gel (200 mg/kg 46%: adjusted risk difference (aRD)=-14%, 95% CI -35%, 7%; 400 mg/kg 48%: aRD=-7%, 95% CI -27%, 12%; 800 mg/kg 45%: aRD=-14%, 95% CI -36%, 9%; 1000 mg/kg 50%: aRD=-8%, 95% CI -29%, 13%). Children exposed to any dose of dextrose gel (combined), compared with placebo, had a lower risk of motor impairment (3% vs 14%, aRD=-11%, 95% CI -19%, -3%) and higher mean (SD) cognitive scores (106.0 (15.3) vs 101.1 (15.7), adjusted mean difference=5.4, 95% CI 1.8, 8.9).
Conclusions:
Prophylactic neonatal dextrose gel did not alter neurocognitive impairment at early school age but may have motor and cognitive benefits. Further school-age follow-up studies are needed.
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