Cheap solution to help prevent cause of brain damage in newborns

A cheap and easy-to-administer dextrose gel should be used to treat low blood sugars in newborns, according to New Zealand research just published in the internationally respected medical journal, The Lancet.

Low blood sugar or neonatal hypoglycaemia is a common problem that affects up to 15 per cent of otherwise healthy babies and is a preventable cause of brain damage, says study leader Professor Jane Harding from the University of Auckland.

The research was carried out at the University’s Liggins Institute and at Waikato Women’s Hospital in Hamilton where PhD student and Neonatal Nurse Practitioner Deborah Harris recruited the families involved.

“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 hypoglycaemia, and is safe and simple to use”, says Professor Harding.
“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”**.

Dextrose gel is already used to reverse hypoglycaemia in people with diabetes, but little evidence exists for its use in babies. Currently, treatment for late preterm and term babies involves extra feeding and repeated blood tests to measure blood sugar levels. But many babies are admitted to intensive care and given intravenous glucose because their blood sugar remains low.

The Sugar Babies Study was designed to assess whether treatment with dextrose gel is more effective than feeding alone at reversing neonatal hypoglycaemia in at-risk babies (eg, from pregnancies complicated by maternal diabetes, preterm birth, and low birthweight).

Between 2008 and 2010, 514 at-risk babies aged 35 weeks gestation or older from Waikato Women’s Hospital in Hamilton, New Zealand, were enrolled in the first 48 hours after birth. 242 (47%) became hypoglycaemic and were randomly assigned to 40% dextrose gel or placebo gel for up to six doses over 48 hours.

Treatment with dextrose almost halved the likelihood of treatment failure (a blood glucose concentration of less than 2.6 mmol/L 30 min after the second of two doses of gel) compared with placebo, with no adverse effects.
Babies given dextrose gel were also less likely to be admitted to intensive care for hypoglycaemia, to receive additional formula feeds, and to be formula fed at two weeks.

“In the past, babies with hypoglycaemia have often been given formula in the first few hours after birth, and if that did not work, then they were admitted to intensive care and put on a drip,” says Professor Harding. The dextrose gel improves the rate of breast feeding and we think this might be because babies stay with their mothers, and are not given formula in the first few hours to manage their hypoglycaemia.”

Professor Harding says, “Because this treatment is inexpensive and simple to administer, it should be considered for first-line management of late preterm and term hypoglycaemic babies 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 hypoglycaemia is common and underdiagnosed.”
“This is exciting, because the treatment is a simple, cheap and safe option that can be used anywhere,” says Professor Harding. “It is a fantastic opportunity to decrease the amount of intervention and high tech treatments these babies need and so keep them out of intensive care and with their mothers.”

In a linked comment, Dr Neil Marlow from the Institute for Women’s Health at University College London notes that, “Dextrose gel has been recommended before, roughly 20 years ago, but a previous randomised trial…did not show differences and…for most services, the use of buccal dextrose, even as an emergency stop-gap, has fallen into disuse. We now have high quality evidence that it is of value and should be part of the response to triggering treatment.”

He calls for more research to refine operational definitions of the level of blood glucose that should trigger treatment response, but notes that “Until more information is available, practice will continue to be based on uncertain facts; however, use of buccal dextrose gel should help to minimise unnecessary interventions.”

The paper is available at this link.