ESPE Yearbook of Paediatric Endocrinology

To read the full abstract: J Pediatr. 2017 Nov;190:136-141

Neonatal hypoglycaemia is common, affecting around 15% of at risk newborns such as preterm, IUGR and infants of diabetic mothers. Delay and inappropriate treatment of hypoglycemia can lead to irreversible brain damage. It is frequently managed by providing infants with an alternative source of glucose, given enterally with infant formula or intravenously with dextrose solution. This often means that mother and baby are separated and may inhibit breastfeeding. There are now several studies assessing the effectiveness of oral dextrose gel to treat neonatal hypoglycemia; the evidence suggests that it is effective and prevents NICU admissions. 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. Treatment of infants with neonatal hypoglycaemia with 40% dextrose gel reduces the incidence of mother-infant separation and increases the likelihood of full breast feeding after discharge compared with placebo gel. There is no evidence of adverse effects during the neonatal period or at two years’ corrected age. Oral dextrose gel should be considered first-line treatment for infants with neonatal hypoglycaemia.

The first study by Coors et al. shows that prophylactic dextrose administered to at risk newborns does not reduce the frequency of transient neonatal hypoglycemia or NICU admissions for hypoglycemia.

Second, Harris DL et al. report increased blood glucose levels after the administration of buccal dextrose gel to infants at risk of hypoglycemia.

Given the findings of Harris et al., is it not clear why the dextrose gel did not not reduce the frequency of transient neonatal hypoglycemia or NICU admissions for hypoglycemia in the Coors study. The authors suggest that the high concentration of Insta-Glucose (77%) used may have caused a hyperinsulinemic response, or alternatively, exogenous enteral dextrose influences glucose homeostasis minimally during the first few hours when counter-regulatory mechanisms are especially active. Thus further studies are required understand the effectiveness of dextrose gel in the first few hours after birth to prevent and treating neonatal hypoglycemia.