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. 2022 Mar 18;3(3):CD011027.
doi: 10.1002/14651858.CD011027.pub3.

Oral dextrose gel for the treatment of hypoglycaemia in newborn infants

Taygen Edwards  1 , Gordon Liu  1 , Malcolm Battin  2 , Deborah L Harris  3   4 , Joanne E Hegarty  2 , Philip J Weston  3 , Jane E Harding  1
Affiliations

Oral dextrose gel for the treatment of hypoglycaemia in newborn infants

Taygen Edwards et al. Cochrane Database Syst Rev. .

Abstract

Background: Neonatal hypoglycaemia, a common condition, can be associated with brain injury. It is frequently managed by providing infants with an alternative source of glucose, often given enterally with milk-feeding or intravenously with dextrose solution, which may decrease breastfeeding success. Intravenous dextrose also often requires that mother and baby are cared for in separate environments. Oral dextrose gel is simple and inexpensive, and can be administered directly to the buccal mucosa for rapid correction of hypoglycaemia, in association with continued breastfeeding and maternal care. This is an update of a previous review published in 2016.

Objectives: To assess the effectiveness of oral dextrose gel in correcting hypoglycaemia in newborn infants from birth to discharge home and reducing long-term neurodevelopmental impairment.

Search methods: We searched the Cochrane Central Register of Controlled Trials, MEDLINE, and Embase from database inception to October 2021. We also searched international clinical trials networks, the reference lists of included trials, and relevant systematic reviews identified in the search. SELECTION CRITERIA: We included randomised controlled trials (RCTs) and quasi-RCTs comparing oral dextrose gel versus placebo, no treatment, or other therapies for the treatment of neonatal hypoglycaemia in newborn infants from birth to discharge home.

Data collection and analysis: Two review authors independently assessed study quality and extracted data; they did not assess publications for which they were study authors. We contacted investigators to obtain additional information. We used fixed-effect models and the GRADE approach to assess the certainty of evidence.

Main results: We included two studies conducted in high-income countries, involving 312 late preterm and at-risk term infants and comparing oral dextrose gel (40% concentration) to placebo gel. One study was at low risk of bias, and the other (an abstract) was at unclear to high risk of bias. Oral dextrose gel compared with placebo gel probably increases correction of hypoglycaemic events (rate ratio 1.08, 95% confidence interval (CI) 0.98 to 1.20; rate difference 66 more per 1000, 95% CI 17 fewer to 166 more; 1 study; 237 infants; moderate-certainty evidence), and may result in a slight reduction in the risk of major neurological disability at age two years or older, but the evidence is uncertain (risk ratio (RR) 0.46, 95% CI 0.09 to 2.47; risk difference (RD) 24 fewer per 1000, 95% CI 41 fewer to 66 more; 1 study, 185 children; low-certainty evidence). The evidence is very uncertain about the effect of oral dextrose gel compared with placebo gel or no gel on the need for intravenous treatment for hypoglycaemia (RR 0.78, 95% CI 0.46 to 1.32; RD 37 fewer per 1000, 95% CI 91 fewer to 54 more; 2 studies, 312 infants; very low-certainty evidence). Investigators in one study of 237 infants reported no adverse events (e.g. choking or vomiting at the time of administration) in the oral dextrose gel or placebo gel group (low-certainty evidence). Oral dextrose gel compared with placebo gel probably reduces the incidence of separation from the mother for treatment of hypoglycaemia (RR 0.54, 95% CI 0.31 to 0.93; RD 116 fewer per 1000, 95% CI 174 fewer to 18 fewer; 1 study, 237 infants; moderate-certainty evidence), and increases the likelihood of exclusive breastfeeding after discharge (RR 1.10, 95% CI 1.01 to 1.18; RD 87 more per 1000, 95% CI 9 more to 157 more; 1 study, 237 infants; moderate-certainty evidence). AUTHORS' CONCLUSIONS: Oral dextrose gel (specifically 40% dextrose concentration) used to treat hypoglycaemia in newborn infants (specifically at-risk late preterm and term infants) probably increases correction of hypoglycaemic events, and may result in a slight reduction in the risk of major neurological disability at age two years or older. Oral dextrose gel treatment probably reduces the incidence of separation from the mother for treatment and increases the likelihood of exclusive breastfeeding after discharge. No adverse events have been reported. Oral dextrose gel is probably an effective and safe first-line treatment for infants with neonatal hypoglycaemia in high-income settings. More evidence is needed about the effects of oral dextrose gel treatment on later neurological disability and the need for other treatments for hypoglycaemia. Future studies should be conducted in low-and middle-income settings, in extremely and moderately preterm infants, and compare oral dextrose gel with other therapies such as intravenous dextrose. There are two ongoing studies that may alter the conclusions of this review when published.

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Conflict of interest statement

TE: has no interests to declare, independently extracted data from the Harris 2013 and Troughton 2000 studies, and checked against the study report and any available study registration details or protocol.

GL: has no interests to declare, independently extracted data from the Harris 2013 and Troughton 2000 studies, and checked against the study report and any available study registration details or protocol.

PJW: contributed to the design and conduct of one of the included studies (Harris 2013).

DLH: contributed to the design and conduct of one of the included studies (Harris 2013) and was a member of the Steering group for the two follow‐up studies (Harris 2016; Harris 2019).

MB: has no interests to declare.

JE Hegarty: has no interests to declare

JE Harding: contributed to the design and conduct of one of the included studies (Harris 2013), and designed and led the two follow‐up studies (Harris 2016; Harris 2019). The funding source for these studies were: Waikato Medical Research Foundation, the Auckland Medical Research Foundation, the Maurice and Phyllis Paykel Trust, the Health Research Council of New Zealand, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, and the Rebecca Roberts Scholarship.

Figures

1
1
Study flow diagram: review update
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1: Dextrose gel versus control, Outcome 1: Correction of hypoglycaemia for each event of hypoglycaemia (investigator defined)
1.2
1.2. Analysis
Comparison 1: Dextrose gel versus control, Outcome 2: Major neurological disability at age two years or older
1.3
1.3. Analysis
Comparison 1: Dextrose gel versus control, Outcome 3: Receipt of intravenous treatment for hypoglycaemia (for each infant)
1.4
1.4. Analysis
Comparison 1: Dextrose gel versus control, Outcome 4: Number of episodes of hypoglycaemia (for each infant)
1.5
1.5. Analysis
Comparison 1: Dextrose gel versus control, Outcome 5: Improved blood glucose to ≥ 2.6 mmol/L after a single dose of gel (by event)
1.6
1.6. Analysis
Comparison 1: Dextrose gel versus control, Outcome 6: Rebound hypoglycaemia (by event)
1.7
1.7. Analysis
Comparison 1: Dextrose gel versus control, Outcome 7: Increase in blood glucose 30 to 90 minutes after treatment (by event)
1.8
1.8. Analysis
Comparison 1: Dextrose gel versus control, Outcome 8: Duration of hypoglycaemia (by event)
1.9
1.9. Analysis
Comparison 1: Dextrose gel versus control, Outcome 9: Separation from mother for treatment of hypoglycaemia
1.10
1.10. Analysis
Comparison 1: Dextrose gel versus control, Outcome 10: Exclusive breast feeding after discharge (WHO definition)
1.11
1.11. Analysis
Comparison 1: Dextrose gel versus control, Outcome 11: Developmental disability at age two years or older
1.12
1.12. Analysis
Comparison 1: Dextrose gel versus control, Outcome 12: Visual impairment and severity at age two years or older
1.13
1.13. Analysis
Comparison 1: Dextrose gel versus control, Outcome 13: Cerebral palsy and severity at age two years or older
1.14
1.14. Analysis
Comparison 1: Dextrose gel versus control, Outcome 14: Developmental delay/intellectual impairment and severity at age two years or older
1.15
1.15. Analysis
Comparison 1: Dextrose gel versus control, Outcome 15: Executive dysfunction and severity at age two years or older (Executive function composite score at 4.5‐year follow‐up)
1.16
1.16. Analysis
Comparison 1: Dextrose gel versus control, Outcome 16: Executive dysfunction and severity at age two years or older (BRIEF‐P Index ‐ Global Executive Composite at 4.5‐year follow‐up)
1.17
1.17. Analysis
Comparison 1: Dextrose gel versus control, Outcome 17: Behavioural problems and severity at age two years or older
See this image and copyright information in PMC

Update of

References

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