ESPE Yearbook of Paediatric Endocrinology

Pediatrics. 2022 1;149(6):e2021050733. doi: 10.1542/peds.2021-050733. PMID: 35582897.

Brief Summary: This randomized clinical trial in ‘at-risk’ neonates with asymptomatic hypoglycemia tested whether oral dextrose gel prevented the need for intravenous fluids. Oral dextrose gel reduced the need for intravenous fluids as well as admission to the neonatal intensive care unit (NICU).

Hypoglycemia is common in at risk neonates in the first a few days of life. Many of these neonates may require admission to the NICU for intravenous fluids to treat the hypoglycemia. Using oral 40% dextrose gel for treating hypoglycemia may be one way to reduce the need for admission to NICU and intravenous fluids and prevent separation of infant from the mother (1). Its use in neonates has not been associated with any adverse effect until 2 years of age.

In this randomized clinical trial in neonates in high risk groups for hypoglycaemia who presented with asymptomatic hypoglycemia, oral dextrose gel promoted exclusive breastfeeding, and reduced mother-infant dyad separation in the first 48 hours of life. It was effective individually across 3 categories of risk groups, namely small for gestational age infants and intrauterine growth retarded infants, insulin dependent diabetic infants and large for gestational age infants, and late preterm infants.

This trial showed that oral 40% dextrose gel followed by breast feeding (compared to breast feeding alone) was a cost-effective alternative to intravenous fluids for the management of asymptomatic hypoglycemia in at-risk neonates. Oral dextrose gel was not associated with any adverse effects and was readily accepted by the mothers involved in the study. The use of continuous glucose monitoring in this study would have potentially provided more accurate and real time glucose measurements.

Reference: 1. Weston PJ, Harris DL, Battin M, Brown J, Hegarty JE, Harding JE. Oral dextrose gel for the treatment of hypoglycaemia in newborn infants. Cochrane Database Syst Rev. 2016; (5):CD011027.