Simple solution for common neonatal problem

A glucose gel rubbed inside the mouths of new-born babies could be an effective way to prevent a common neonatal condition which sometimes leads to brain damage.

Professor Jane Harding and her team at the Liggins Institute have already shown that the gel can reverse low blood sugar levels (hypoglycaemia) in newborns. A project grant announced in the latest NZ Health Research Council funding round will allow the investigators to conduct a clinical trial to test whether they can use the gel to prevent this problem in babies who are at risk.

Professor Harding says that up to 15% of new born babies will have low blood glucose concentrations and the rate is much higher in babies who have additional risk factors: up to 50% in babies of diabetic mothers and 66% in preterm babies. In some cases, hypoglycaemia can cause brain damage and death.

If the trial results show that the dextrose (glucose) gel does prevent hypoglycaemia, this approach would have huge advantages for the babies and their families. Current treatments usually mean admission to the newborn intensive care unit (NICU) which separates mothers and babies, interferes with the establishment of breast-feeding and incurs high social and financial cost.

“We have already shown that treating neonatal hypoglycaemia with dextrose gel was more effective than feeding alone in reversing hypoglycaemia,” says Professor Harding. “It reduced both the rate of NICU admission for hypoglycaemia and the rate of formula feeding at two weeks of age. Importantly, the gel is cheap, well tolerated, simple and safe to administer, and was acceptable to families and caregivers.

“Our next step is to determine whether oral dextrose gel is effective in preventing hypoglycaemia, and hence in preventing many of the adverse effects associated with this common problem.”

Reducing the number of admissions to NICU would also have a significant economic impact, with current care and treatment estimated to cost the country at least $9.4 million annually.

If successful, this intervention is likely to rapidly transform the management of neonatal hypoglycaemia throughout the world. It requires no special expertise or equipment and hence is applicable in almost any birth setting.

The double-blinded, randomised, placebo-controlled trial will take place at centres across New Zealand. Babies who are at risk of hypoglycaemia (infants of diabetic mothers, preterm, small and large babies) and unlikely to be admitted to NICU for other reasons will be randomised to have the dextrose gel or identically appearing placebo gel massaged into the inside of their mouths soon after birth. They will be managed according to the usual hospital protocol, including monitoring of blood glucose concentrations. The primary outcome will be admission to NICU; secondary outcomes will include incidence of hypoglycaemia, breastfeeding rates, and costs of care before discharge.