新生児の低血糖症に対するデクストロースゲル (シュガーベイビーズ研究):ランダム化,ダブルブラインド,プラセボ対照試験
Deborah L Harris1, Philip J Weston2, Matthew Signal3
1Newborn Intensive Care Unit, Waikato District Health Board, Hamilton, New Zealand; Liggins Institute, University of Auckland, Auckland, New Zealand.
Lancet (London, England)
|October 1, 2013
まとめ
デクストロースゲルは,リスクの高い乳児の新生児低血糖症を効果的に治療し,プラセボと比較して治療失敗を減らす. この単純な介入は,新生児の低血糖管理のための有望な第一線アプローチを提供します.
科学分野:
- 新生児医学 新生児医学
- 小児内分泌学について
背景:
- 新生児の低血糖症は,乳児の脳損傷の一般的な状態であり,予防可能な原因である.
- 新生児における低血糖症の治療におけるデクストロゼルの有効性に関する証拠は限られている.
研究 の 目的:
- リスクのある乳児における新生児低血糖症の逆転のために,デクストロースゲルの効果を単独の給餌と比較して評価する.
主な方法:
- ランダム化,ダブルブラインド,プラセボ対照試験は,237人のリスク児 (35-42週妊娠,48時間未満) を対象に実施されました.
- 乳児は40%のデクストロースゲル (200 mg/kg) またはプラセボゲルを投与され,治療失敗は2回の試行後に血糖 <2.6 mmol/Lと定義された.
主要な成果:
- デクストロースゲルは,プラセボと比較して治療失敗を著しく減少させた (14%対24%,RR0.57,p=0.04).
- 重篤な有害事象は報告されませんでしたが,プラセボ群の3人の乳児は1回の低血糖値 (0.9 mmol/L) を記録しました.
結論:
- デクストロースゲルは,早産後期および早産後の新生児における新生児低血糖症の安価で簡単なファーストライン治療です.
- 生後48時間以内に低血糖症の管理に用いるデクストロズゲルの検討は推奨されます.
関連する概念動画
Hypoglycemia and Glucagon
Without prolonged fasting, healthy individuals maintain blood glucose levels above 3.5 mM due to a well-adapted neuroendocrine counterregulatory system that effectively prevents acute hypoglycemia, a potentially life-threatening condition. The primary clinical scenarios for hypoglycemia encompass diabetes treatment, inappropriate production of endogenous insulin or insulin-like substances by tumors, and the use of glucose-lowering agents in non-diabetic individuals. Notably, hypoglycemia in the...
Glucose Transporters
Glucose transporters facilitate the transport of glucose across the cell membrane. In addition to glucose, some glucose transporters can also aid the movement of other hexoses such as fructose, mannose, and galactose.
Facilitated diffusion-glucose transporters (GLUTs) are encoded by the solute-linked carrier (SLC) family 2, subfamily A gene family, or SLC2A. The 14 GLUT protein members are distributed into three classes:
Facilitated diffusion-glucose transporters (GLUTs) are encoded by the solute-linked carrier (SLC) family 2, subfamily A gene family, or SLC2A. The 14 GLUT protein members are distributed into three classes:
Drug Dosing: Infants and Children
Pediatric patient dosages diverge from adults due to disparities in body surface area, total body water, and extracellular fluid per kilogram of body weight. The dosing regimen considers the variations in pharmacokinetics and pharmacology across distinct age groups, encompassing preterm newborns, infants, young children, older children, and adolescents. Calculation of pediatric patient doses is predicated on determining body surface area, which exhibits a superior correlation with the child's...
Oral Hypoglycemic Agents: Glinides
Repaglinide (Prandin) and Nateglinide (Starlix), known as glinides, are oral insulin secretagogues that stimulate insulin release from pancreatic β cells by closing the ATP-sensitive potassium channels (KATP channel). Repaglinide controls insulin release from pancreatic β cells by managing potassium efflux. It shares two binding sites with sulfonylureas and also has a unique site, indicating overlapping mechanisms of action. With a rapid onset and a 4-7 hour duration, it effectively manages...
Hypoglycemia
Hypoglycemia is a blood glucose level below 70 mg/dL. It commonly occurs in individuals using insulin or insulin-secreting drugs, but may also arise in non-diabetic conditions. People with type 1 diabetes are at the highest risk because they depend on exogenous insulin. People with type 2 diabetes are also at risk, especially when treated with insulin or medications such as sulfonylureas, which increase insulin release regardless of blood glucose levels. It develops when insulin levels exceed...
Diabetes Mellitus: Type 2 and Gestational
Type 2 diabetes, characterized by insulin resistance, arises when the insulin receptors on cells lose responsiveness to insulin, diminishing the cell's capacity to take up glucose, resulting in elevated blood glucose levels. To receive a diagnosis of Type 2 diabetes, a series of blood glucose tests are necessary to assess whether the blood glucose falls within normal parameters. If the result is out of the normal range, a patient may be diagnosed as prediabetic or diabetic, depending on the...


