Neonatal hypoglycaemia

Abstract

Aim Neonatal hypoglycaemia is common, and can cause brain damage and death. We aimed to determine if prophylactic oral dextrose gel given to newborn babies at risk prevents neonatal hypoglycaemia and thus reduces its potential sequelae. Method First, we conducted an eight-arm placebo controlled randomised dosage trial to select the most effective dose of dextrose gel in prevention of neonatal hypoglycaemia. Secondly, the main trial is ongoing to determine the effect of the selected prophylactic dose on admission to neonatal intensive care. Thirdly, follow-up is ongoing to determine the later benefits and harms of prophylactic dextrose gel. To formally evaluate the evidence for dextrose gel in prevention of neonatal hypoglycaemia we undertook a Cochrane systematic review. Finally, we investigated the effect of prophylactic dextrose gel on neonatal hypoglycaemia and survival in lambs. Findings We demonstrated that the incidence of neonatal hypoglycaemia can be reduced with a single dose of dextrose gel 200 mg/kg, with a number needed to treat of ten. We have used this dose in finalising the protocol for the main multicentre randomised placebo controlled trial, which is recruiting 2,129 babies, with the primary outcome being admission to neonatal intensive care. Secondary outcomes include hypoglycaemia, breastfeeding, healthcare costs and later neurosensory disability. In the first 100 babies assessed at age two years’ corrected age, we achieved 90% follow-up. Although 30% had neurosensory disability, this cohort has better developmental scores than previous cohorts of babies at risk of neonatal hypoglycaemia. Lambs randomised to dextrose gel did not have higher blood glucose concentrations or better survival than those randomised to placebo. Low temperature at one hour after birth, rather than birthweight or blood glucose concentrations was associated with decreased survival. Conclusion Prophylactic oral dextrose gel is effective in reducing the incidence of neonatal hypoglycaemia in babies at risk. If ongoing studies show that admission to neonatal intensive care is avoided, and there are no harms demonstrated at follow-up, then oral dextrose gel for prevention of neonatal hypoglycaemia is likely to be rapidly translated into standard clinical practice, with potential for improving outcomes while reducing costs.