A new study suggests that dextrose gel should be used to treat low blood sugars in newborn babies (neonatal-hypoglycemia) – a common and preventable cause of brain damage.
Dextrose gel is an oral glucose gel, already used as form of treatment for reversal of hypoglycemia in diabetics. But researchers from New Zealand say the gel could be a cheap, effective and easy-to-use treatment for hypoglycemic newborn infants.
At present, treatment for late preterm and term babies suffering from hypoglycemia involves additional feeding and repeated blood tests in order to measure blood sugar levels.
However, many babies are admitted to intensive care and given intravenous glucose as a result of continuous low blood sugar levels.
According to the Yale School of Medicine, around 1 in 3 newborn babies suffer from hypoglycemia. Newborns are at higher risk of the condition if the mother is diabetic, if they are small for their gestational age, or if they are growth-restricted, preterm or born under significant stress.
Severe or prolonged hypoglycemia in newborns could lead to seizures and serious brain injury.
The study, published in The Lancet, involved analyzing 514 babies at high risk of hypoglycemia aged 35 weeks’ gestation or older. All newborns were enrolled in the study within 48 hours after birth.
Of the newborns, 242 (47%) developed hypoglycemia and were randomly assigned to a treatment of either a 40% dextrose gel or a placebo gel. Six doses were administered over 48 hours by applying the gel to the inside of the babies’ cheeks (buccal).
Newborn babies who were treated with dextrose gel revealed a blood glucose concentration of less than 2.6 mmol/L 30 minutes following the second of two doses of gel – showing almost half the risk of treatment failure, compared with the newborns who were treated with the placebo.
Furthermore, babies treated with dextrose gel were less likely to be admitted to intensive care as a result of hypoglycemia, less likely to need additional formula feeds, and were less likely to be formula fed at 2 weeks.
Professor Jane Harding, of the University of Auckland in New Zealand, says:
“Our study is the first report in babies showing that dextrose gel massaged into the inside of the cheek is more effective than feeding alone for treating hypoglycemia, and is safe and simple to use.
Dextrose gel treatment costs roughly $2 per baby and could help reduce admissions to neonatal intensive care for treatment with intravenous glucose – not only reducing costs but importantly, keeping mothers and babies together to encourage breastfeeding.”
Prof. Harding adds that because the treatment is inexpensive and easy to administer, it should be considered as a first-line treatment of late preterm and term hypoglycemic infants in the first 48 hours after birth.
“[Dextrose gel] can easily be made in the hospital pharmacy, and is stable at room temperature. Therefore, the gel could also be useful in resource-poor settings where hypoglycemia is common and underdiagnosed,” she adds.
In a linked comment following the study, Neil Marlow, of the Institute for Women’s Health at University College London in the UK, says that there is now high-quality evidence that buccal dextrose gel is of value and should be “part of the response to the triggering of treatment.”
He notes, however, that further research is needed to refine “operational definitions” of the level of blood glucose that should trigger treatment response:
“Until more information is available, practice will continue to be based on uncertain facts. However, use of buccal dextrose gel should help to minimize unnecessary interventions.”