Abstract:
Neonatal hypoglycaemia occurs in 5-15% of healthy infants and up to 50% of those with risk
factors including being born small, large, late-preterm, or to mothers with diabetes. The
majority of cases are asymptomatic, and whilst screening of infants at risk is recommended,
cot-side monitoring of blood glucose concentrations is frequently performed using inaccurate
non-enzymatic glucometers that require laboratory confirmation of low concentrations. Across
the first week after birth, used a decision tree model to show that the use of enzymatic
glucometers costs less than non-enzymatic glucometers (NZ$87 vs NZ$97).
Initial management of neonatal hypoglycaemia usually involves increased feeding, but oral
dextrose gel has now been shown to be safe and effective. In a decision tree model examining
the initial postnatal hospital stay, we showed that treating neonatal hypoglycaemia using oral
dextrose gel reduced costs from a healthcare provider perspective by around NZ$1300 per
infant with hypoglycaemia.
The financial and quality-of-life burden of neonatal hypoglycaemia may last a lifetime. We
used a decision analytic model from a health-system perspective to show that poor
neurodevelopmental outcomes (cerebral palsy, learning disabilities, seizures, vision disorders)
are more likely amongst in those who experienced neonatal hypoglycaemia (24%) than those
who did not (4.6%). Over an 80 year time horizon, individuals who experience neonatal
hypoglycaemia had postnatal hospital and post-discharge costs approximately NZ$66,000
higher than those who did not, along with a net monetary loss (including monetised QALYs)
of approximately NZ$180,000.
Most clinical guidelines also recommend the use of prophylactic measures. Prophylactic oral
dextrose gel has been shown to reduce, but not abolish, the risk of neonatal hypoglycaemia.
From the perspective of the health system over an18-year time horizon, we used a decision tree
to show that prophylactic dextrose gel dominates no prophylaxis, with a cost saving of around
NZ$3,000 and an increase of around 0.15 QALYs per infant.
We recommend routine use of enzymatic glucometers for cot-side screening; buccal dextrose
gel for initial treatment; and that prophylactic dextrose gel be considered in infants at risk of
neonatal hypoglycaemia on the basis that these measures are likely to be cost-effective and low
risk.