Prophylactic Dextrose Gel Does Not Prevent Neonatal Hypoglycemia: A Quasi-Experimental Pilot Study - 22/06/18
, Joshua J. Cousin, MD 1, Joseph L. Hagan, ScD 1, Jeffrey R. Kaiser, MD, MA 1, 2Abstract |
Objective |
To test the hypothesis that prophylactic dextrose gel administered to newborn infants at risk for hypoglycemia will increase the initial blood glucose concentration after the first feeding and decrease neonatal intensive care unit (NICU) admissions for treatment of asymptomatic neonatal hypoglycemia compared with feedings alone.
Study design |
This quasi-experimental study allocated asymptomatic at-risk newborn infants (late preterm, birth weight <2500 or >4000 g, and infants of mothers with diabetes) to receive prophylactic dextrose gel (Insta-Glucose; Valeant Pharmaceuticals North America LLC, Bridgewater, New Jersey); other at-risk infants formed the control group. After the initial feeding, the prophylactic group received dextrose gel (0.5 mL/kg) rubbed into the buccal mucosa. The blood glucose concentration was checked 30 minutes later. Initial glucose concentrations and rate of NICU admissions were compared between the prophylactic group and controls using bivariate analyses. A multivariable linear regression compared first glucose concentrations between groups, adjusting for at-risk categories and age at first glucose concentration.
Results |
There were 236 subjects (72 prophylactic, 164 controls). The first glucose concentration was not different between the prophylactic and control groups in bivariate analysis (52.1 ± 17.1 vs 50.5 ± 15.3 mg/dL, P = .69) and after adjusting for covariates (P = .18). Rates of NICU admission for treatment of transient neonatal hypoglycemia were 9.7% and 14.6%, respectively (P = .40).
Conclusions |
Prophylactic dextrose gel did not reduce transient neonatal hypoglycemia or NICU admissions for hypoglycemia. The carbohydrate concentration of Insta-Glucose (77%) 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.
Trial registration |
ClinicalTrials.gov: NCT02523222.
Le texte complet de cet article est disponible en PDF.Abbreviations : BW, HHBTH, IMD, IV, LGA, NICU, NICU2, SGA
Plan
| Supported by a Thrasher Research Fund Early Career Award, Salt Lake City, UT (12990); the Texas Pediatric Society Foundation, Austin, TX; and the Baylor College of Medicine Evangelina “Evie” Whitlock Fellowship Award in Neonatology, Houston, TX (to S.C.). Those providing support were not involved in the study design, methods, data collection, analysis, results, manuscript preparation, or the decision to submit the paper for publication. J.H. received salary support from the Texas Pediatric Society Foundation. The authors declare no conflicts of interest. |
|
| Portions of this study were presented as an abstract at the Southern Society for Pediatric Research annual meeting, New Orleans, LA, February 12, 2017, and the Pediatric Academic Societies annual meeting, San Francisco, CA, May 6-9, 2017. |
Vol 198
P. 156-161 - juillet 2018 Retour au numéro
Article précédent
- Cost Analysis of Treating Neonatal Hypoglycemia with Dextrose Gel
- Matthew J. Glasgow, Jane E. Harding, Richard Edlin
- Neonatal Intensive Care Unit Length of Stay Reduction by Heart Rate Characteristics Monitoring
- Jonathan R. Swanson, William E. King, Robert A. Sinkin, Douglas E. Lake, Waldemar A. Carlo, Robert L. Schelonka, Peter J. Porcelli, Christina T. Navarrete, Eduardo Bancalari, Judy L. Aschner, Jose A. Perez, T. Michael O'Shea, M. Whit Walker
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?