ESPE Yearbook of Paediatric Endocrinology

Cochrane Database Syst Rev. 2022 Mar 18;3(3):CD011027. doi: 10.1002/14651858.CD011027.pub3. PMID: 35302645.

Brief Summary: This systematic review assessed the evidence for oral dextrose gel to treat hypoglycemia in newborns. Oral dextrose gel compared with placebo gel probably improved the correction of hypoglycaemic events and may result in a slight reduction in the risk of major neurological disability at 4.5 years corrected age, but the evidence is still uncertain.

Neonatal hypoglycaemia is a common condition affecting about 5% to 15% of infants in the immediate postnatal period, especially in the at-risk group pf infants such as the IUGR, preterm and the infants of diabetic mothers. It can be associated with brain injury, developmental problems and poor later school performance. Once diagnosed the management involves increased feeding, supplemental infant formula or intravenous dextrose. Supplemental infant formula may disrupt the establishment of breastfeeding. Intravenous dextrose is expensive, usually requires separation of mother and infant and is not always available in resource-poor settings, or settings providing lower levels of perinatal care.

Oral dextrose gel is now widely used, and is increasingly recommended as a first-line treatment for asymptomatic neonatal hypoglycaemia (1). This review assessed the effectiveness of administering oral dextrose gel to correct hypoglycaemia in newborn infants from birth to discharge and reducing long-term neurodevelopmental impairment. The current evidence shows that oral dextrose gel compared with placebo gel probably increases the correction of hypoglycaemic events and may result in a slight reduction in the risk of major neurological disability at 4.5 years corrected age, but the evidence was still uncertain. The fact that oral dextrose gel probably corrected hypoglycaemic events and led to higher blood glucose concentrations while reducing maternal-infant separation and improving exclusive breastfeeding after discharge were important indicators of the utility of oral dextrose gel, especially in the absence of evidence of adverse events during the neonatal period.

A cost analysis also reported that treating neonatal hypoglycaemia with oral dextrose gel was likely to result in greater cost savings than a standard approach. Oral dextrose gel is a simple, low-cost, and possibly effective treatment for initial treatment of infants with neonatal hypoglycaemia during the first 48 hours after birth. Available evidence does not support extrapolation to other contexts, or to either extremely or moderately preterm infants. Future studies should examine the use of oral dextrose gel in a variety of settings (resource poor setting) and patient groups (pre-term infants).

Reference: 1. Alsweiler JM, Woodall SM, Crowther CA, Harding JE. Oral dextrose gel to treat neonatal hypoglycaemia: clinician survey. Journal of Paediatrics and Child Health 2019;55:844–50.