Oral dextrose gel for the treatment of hypoglycaemia in newborn infants.

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dc.contributor.author Edwards, Taygen
dc.contributor.author Liu, Gordon
dc.contributor.author Battin, Malcolm
dc.contributor.author Harris, Deborah L
dc.contributor.author Hegarty, Joanne E
dc.contributor.author Weston, Philip J
dc.contributor.author Harding, Jane E
dc.coverage.spatial England
dc.date.accessioned 2022-05-06T04:41:24Z
dc.date.available 2022-05-06T04:41:24Z
dc.date.issued 2022-03-18
dc.identifier.citation (2022). Cochrane Database of Systematic Reviews, 3(3), CD011027-.
dc.identifier.issn 1469-493X
dc.identifier.uri https://hdl.handle.net/2292/59035
dc.description.abstract <h4>Background</h4>Neonatal hypoglycaemia, a common condition, can be associated with brain injury. It is frequently managed by providing infants with an alternative source of glucose, often given enterally with milk-feeding or intravenously with dextrose solution, which may decrease breastfeeding success. Intravenous dextrose also often requires that mother and baby are cared for in separate environments. Oral dextrose gel is simple and inexpensive, and can be administered directly to the buccal mucosa for rapid correction of hypoglycaemia, in association with continued breastfeeding and maternal care. This is an update of a previous review published in 2016.<h4>Objectives</h4>To assess the effectiveness of oral dextrose gel in correcting hypoglycaemia in newborn infants from birth to discharge home and reducing long-term neurodevelopmental impairment.<h4>Search methods</h4>We searched the Cochrane Central Register of Controlled Trials, MEDLINE, and Embase from database inception to October 2021.  We also searched international clinical trials networks, the reference lists of included trials, and relevant systematic reviews identified in the search.  SELECTION CRITERIA: We included randomised controlled trials (RCTs) and quasi-RCTs comparing oral dextrose gel versus placebo, no treatment, or other therapies for the treatment of neonatal hypoglycaemia in newborn infants from birth to discharge home.<h4>Data collection and analysis</h4>Two review authors independently assessed study quality and extracted data; they did not assess publications for which they were study authors. We contacted investigators to obtain additional information. We used fixed-effect models and the GRADE approach to assess the certainty of evidence.<h4>Main results</h4>We included two studies conducted in high-income countries, involving 312 late preterm and at-risk term infants and comparing oral dextrose gel (40% concentration) to placebo gel. One study was at low risk of bias, and the other (an abstract) was at unclear to high risk of bias. Oral dextrose gel compared with placebo gel probably increases correction of hypoglycaemic events (rate ratio 1.08, 95% confidence interval (CI) 0.98 to 1.20; rate difference 66 more per 1000, 95% CI 17 fewer to 166 more; 1 study; 237 infants; moderate-certainty evidence), and may result in a slight reduction in the risk of major neurological disability at age two years or older, but the evidence is uncertain (risk ratio (RR) 0.46, 95% CI 0.09 to 2.47; risk difference (RD) 24 fewer per 1000, 95% CI 41 fewer to 66 more; 1 study, 185 children; low-certainty evidence). The evidence is very uncertain about the effect of oral dextrose gel compared with placebo gel or no gel on the need for intravenous treatment for hypoglycaemia (RR 0.78, 95% CI 0.46 to 1.32; RD 37 fewer per 1000, 95% CI 91 fewer to 54 more; 2 studies, 312 infants; very low-certainty evidence). Investigators in one study of 237 infants reported no adverse events (e.g. choking or vomiting at the time of administration) in the oral dextrose gel or placebo gel group (low-certainty evidence).  Oral dextrose gel compared with placebo gel probably reduces the incidence of separation from the mother for treatment of hypoglycaemia (RR 0.54, 95% CI 0.31 to 0.93; RD 116 fewer per 1000, 95% CI 174 fewer to 18 fewer; 1 study, 237 infants; moderate-certainty evidence), and increases the likelihood of exclusive breastfeeding after discharge (RR 1.10, 95% CI 1.01 to 1.18; RD 87 more per 1000, 95% CI 9 more to 157 more; 1 study, 237 infants; moderate-certainty evidence).   AUTHORS' CONCLUSIONS: Oral dextrose gel (specifically 40% dextrose concentration) used to treat hypoglycaemia in newborn infants (specifically at-risk late preterm and term infants) probably increases correction of hypoglycaemic events, and may result in a slight reduction in the risk of major neurological disability at age two years or older. Oral dextrose gel treatment probably reduces the incidence of separation from the mother for treatment and increases the likelihood of exclusive breastfeeding after discharge. No adverse events have been reported. Oral dextrose gel is probably an effective and safe first-line treatment for infants with neonatal hypoglycaemia in high-income settings.  More evidence is needed about the effects of oral dextrose gel treatment on later neurological disability and the need for other treatments for hypoglycaemia. Future studies should be conducted in low-and middle-income settings, in extremely and moderately preterm infants, and compare oral dextrose gel with other therapies such as intravenous dextrose. There are two ongoing studies that may alter the conclusions of this review when published.
dc.format.medium Electronic
dc.language eng
dc.publisher Wiley
dc.relation.ispartofseries The Cochrane database of systematic reviews
dc.rights Items in ResearchSpace are protected by copyright, with all rights reserved, unless otherwise indicated. Previously published items are made available in accordance with the copyright policy of the publisher.
dc.rights.uri https://researchspace.auckland.ac.nz/docs/uoa-docs/rights.htm
dc.rights.uri https://documentation.cochrane.org/display/EPPR/Standard+%7C+Cochrane+Review
dc.subject Perinatal Period - Conditions Originating in Perinatal Period
dc.subject Preterm, Low Birth Weight and Health of the Newborn
dc.subject Clinical Research
dc.subject Pediatric
dc.subject Infant Mortality
dc.subject Neurosciences
dc.subject Clinical Trials and Supportive Activities
dc.subject 6.1 Pharmaceuticals
dc.subject Reproductive health and childbirth
dc.subject 3 Good Health and Well Being
dc.subject 11 Medical and Health Sciences
dc.subject 17 Psychology and Cognitive Sciences
dc.title Oral dextrose gel for the treatment of hypoglycaemia in newborn infants.
dc.type Journal Article
dc.identifier.doi 10.1002/14651858.cd011027.pub3
pubs.issue 3
pubs.begin-page CD011027
pubs.volume 3
dc.date.updated 2022-04-06T18:31:50Z
dc.rights.holder Copyright: The Cochrane Collaboration en
dc.identifier.pmid 35302645 (pubmed)
pubs.author-url https://www.ncbi.nlm.nih.gov/pubmed/35302645
pubs.publication-status Published
dc.rights.accessrights http://purl.org/eprint/accessRights/RetrictedAccess en
pubs.subtype Review
pubs.subtype Journal Article
pubs.elements-id 890874
pubs.org-id Liggins Institute
pubs.org-id Medical and Health Sciences
pubs.org-id School of Medicine
pubs.org-id Paediatrics Child & Youth Hlth
pubs.org-id LiFePATH
dc.identifier.eissn 1469-493X
pubs.record-created-at-source-date 2022-04-07
pubs.online-publication-date 2022-03-18


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