Glucose Gel as a Potential Alternative Treatment to Infant Formula for Neonatal Hypoglycaemia in Australia

Raenee L Barber, Amy E Ekin, Pushparani Sivakumar, Kay Howard, Therese A O'Sullivan, Raenee L Barber, Amy E Ekin, Pushparani Sivakumar, Kay Howard, Therese A O'Sullivan

Abstract

Infant formula is often used as a treatment for neonatal hypoglycaemia in Australia; however, there are concerns that this may jeopardise mother-baby bonding and breastfeeding. Successful use of glucose gel as an alternative treatment for hypoglycaemia has been reported. We wanted to investigate in a pilot study whether the use of glucose gel has the potential to quickly and safely restore normoglycaemia in the infants of diabetic mothers in an Australian setting. Infants with asymptomatic hypoglycaemia were treated with glucose gel (n = 36) and compared to a historical group of infants which had been treated with infant formula (n = 24). Within 15 min of the first treatment, the gel group had a mean blood glucose level (BGL) of 2.6 mmol/L, and 2.7 mmol/L 30 min after the second treatment. This was lower than the BGL after the first treatment for the formula group, which rose to a mean of 2.8 then to 3.2 mmol/L after the second treatment (p = 0.003). In successfully treated infants, administration of the gel resulted in normoglycaemia within 30 min. The likelihood of special care nursery admission was not significantly different between the groups, although we had a small sample size, and our findings should be interpreted with caution. These pilot results provide support for further investigations into the use of glucose gel as an alternative treatment to infant formula.

Keywords: Glucose gel; breastfeeding; diabetes; hypoglycaemia; infant formula; neonate.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Protocol for selection and treatment of infants, of diabetic mothers, suffering hypoglycaemia for trial of buccal application of glucose gel treatment. BGL: blood glucose levels, BW: body weight
Figure 2
Figure 2
Means of blood glucose response to either infant formula or glucose gel treatment in hypoglycaemic infants born to diabetic mothers. Error bars represent standard error. Blood glucose levels (BGL) were measured 15 min after the first treatment; where required, a second treatment was administered, then the BGL was measured again after 30 min.

References

    1. Hay W., Cornblath M. Historical perspectives: Transient symptomatic neonatal hypoglycemia. NeoReviews. 2003;4:e1–e5. doi: 10.1542/neo.4-1-e1.
    1. Rozance P.J., Hay W.W. Neonatal Hypoglycemia—Answers, but More Questions. J. Pediatr. 2012;161:775–776. doi: 10.1016/j.jpeds.2012.06.034.
    1. Hay W.W., Raju T.N.K., Higgins R.D., Kalhan S.C., Devaskar S.U. Knowledge Gaps and Research Needs for Understanding and Treating Neonatal Hypoglycemia: Workshop Report from Eunice Kennedy Shriver National Institute of Child Health and Human Development. J. Pediatr. 2009;155:612–617. doi: 10.1016/j.jpeds.2009.06.044.
    1. Stenninger E., Flink R., Eriksson B., Sahlen C. Long term neurological dysfunction and neonatal hypoglycaemia after diabetic pregnancy. Arch. Dis. Child. Fetal Neonatal Ed. 1998;79:F174–F179. doi: 10.1136/fn.79.3.F174.
    1. Williams A.F. Hypoglycaemia of the newborn: A review. Bull. World Health Organ. 1997;75:216–290.
    1. Harris D.L., Battin M.R., Weston P.J., Harding J.E. Continuous glucose monitoring in newborn babies at risk of hypoglycemia. J. Pediatr. 2010;157:198–202.e191. doi: 10.1016/j.jpeds.2010.02.003.
    1. Rozance P.J., Hay W.W. Describing hypoglycemia—Definition or operational threshold? Early Hum. Dev. 2010;86:275–280. doi: 10.1016/j.earlhumdev.2010.05.002.
    1. Harris D.L., Weston P.J., Battin M.R., Harding J.E. A survey of the management of neonatal hypoglycaemia within the Australian and New Zealand Neonatal Network. J. Paediatr. Child Health. 2014;50:E55–E62. doi: 10.1111/j.1440-1754.2009.01599.x.
    1. Rozance P., Hay W. New approaches to management of neonatal hypoglycemia. Matern. Health Neonatol. Perinatol. 2016;2:1–7. doi: 10.1186/s40748-016-0031-z.
    1. Newnam K.M., Bunch M. Glucose Gel as a Treatment Strategy for Transient Neonatal Hypoglycemia. Adv. Neonatal. Care. 2017;17:470–477. doi: 10.1097/ANC.0000000000000426.
    1. Hewitt V., Watts R., Robertson J., Haddow G. Nursing and midwifery management of hypoglycaemia in healthy term neonates. Int. J. Evid. Based Healthc. 2005;3:169–205.
    1. Women and Newborn Health Service . Metabolic Management: Neonatology Clinical Guidelines. King Edward Memorial Hospital; Perth, Australia: 2010.
    1. Haninger N.C., Farley C.L. Screening for hypoglycemia in healthy term neonates: Effects on breastfeeding. J. Midwifery Womens Health. 2001;46:292–301. doi: 10.1016/S1526-9523(01)00180-5.
    1. Bourchier D., Burke T. Protocol: Hypoglycaemia in Neonates (Delivery Suite and Postnatal Wards) Waikato District Health Board; Hamilton, New Zealand: 2010.
    1. Barennes H., Pussard E. Improving the management of dysglycemia in children in the developing world. Am. J. Trop. Med. Hyg. 2015;92:6–8. doi: 10.4269/ajtmh.14-0212.
    1. Harris D.L., Gamble G.D., Weston P.J., Harding J.E. What Happens to Blood Glucose Concentrations After Oral Treatment for Neonatal Hypoglycemia? J. Pediatr. 2017;190:136–141. doi: 10.1016/j.jpeds.2017.06.034.
    1. Bourchier D., Weston P., Heron P. Hypostop for neonatal hypoglycaemia. N. Z. Med. J. 1992;105:22.
    1. Ang I., Koh T., O’Halloran M., Berry A. Oromucosal treatment of neonatal hypoglycaemia. J. Paediatr. Child Health. 1991;27:128–129.
    1. Harris D.L., Weston P.J., Harding J.E. Dextrose gel and infant formula are more effective than breast milk for reversing neonal hypoglycaemia. Pediatr. Res. 2011;70:651. doi: 10.1038/pr.2011.876.
    1. Harris D.L., Weston P.J., Signal M., Chase J.G., Harding J.E. Dextrose gel for neonatal hypoglycaemia (the Sugar Babies Study): A randomised, double-blind, placebo-controlled trial. Lancet. 2013;382:2077–2083. doi: 10.1016/S0140-6736(13)61645-1.
    1. Ter M., Halibullah I., Leung L., Jacobs S. Implementation of dextrose gel in the management of neonatal hypoglycaemia. J. Paediatr. Child Health. 2017;53:408–411. doi: 10.1111/jpc.13409.
    1. Narang N., Sharma J. Sublingual mucosa as a route for systemic drug delivery. Int. J. Pharm. Pharm. Sci. 2011;3:18–22.
    1. Barennes H., Willcox M.L., Graz B., Pussard E. Sublingual sugar for infant hypoglycaemia. Lancet. 2014;383:1208. doi: 10.1016/S0140-6736(14)60601-2.
    1. International Diabetes Federation . Diabetes Atlas. International Diabetes Federation; Brussels, Belgium: 2015.
    1. DSS Research Statistical Power Calculators. [(accessed on 28 March 2018)]; Available online: .
    1. Hegarty J.E., Harding J.E., Gamble G.D., Crowther C.A., Edlin R., Alsweiler J.M. Prophylactic Oral Dextrose Gel for Newborn Babies at Risk of Neonatal Hypoglycaemia: A Randomised Controlled Dose-Finding Trial (the Pre-hPOD Study) PLoS Med. 2016;13:e1002155. doi: 10.1371/journal.pmed.1002155.
    1. Bennett C., Fagan E., Chaharbakhshi E., Zamfirova I., Flicker J. Implementing a Protocol Using Glucose Gel to Treat Neonatal Hypoglycemia. Nurs. Womens Health. 2016;20:64–74. doi: 10.1016/j.nwh.2015.11.001.
    1. Crenshaw J. Care Practice #6: No Separation of Mother and Baby, With Unlimited Opportunities for Breastfeeding. J. Perinat. Educ. 2007;16:39–43.
    1. Harris D.L., Alsweiler J.M., Ansell J.M., Gamble G.D., Thompson B., Wouldes T.A., Yu T.Y., Harding J.E. Outcome at 2 Years after Dextrose Gel Treatment for Neonatal Hypoglycemia: Follow-Up of a Randomized Trial. J. Pediatr. 2016;170:54–59. doi: 10.1016/j.jpeds.2015.10.066.
    1. Rawat M., Chandrasekharan P., Turkovich S., Barclay N., Perry K., Schroeder E., Testa L., Lakshminrusimha S. Oral Dextrose Gel Reduces the Need for Intravenous Dextrose Therapy in Neonatal Hypoglycemia. Biomed. Hub. 2016;1 doi: 10.1159/000448511.
    1. Weston P.J., Harris D.L., Battin M., Brown J., Hegarty J.E., Harding J.E. Cochrane Database of Systematic Reviews. John Wiley & Sons, Ltd.; Hoboken, NJ, USA: 2016. Oral dextrose gel for the treatment of hypoglycaemia in newborn infants.
    1. McKinlay C.J., Alsweiler J.M., Ansell J.M., Anstice N.S., Chase J.G., Gamble G.D., Harris D.L., Jacobs R.J., Jiang Y., Paudel N., et al. Neonatal Glycemia and Neurodevelopmental Outcomes at 2 Years. N. Engl. J. Med. 2015;373:1507–1518. doi: 10.1056/NEJMoa1504909.
    1. World Health Organization (WHO) Global Strategy on Infant and Young Child Feeding. WHO; Geneva, Switzerland: 2002.
    1. Wright N. Hypoglycemia in breastfed neonates. Breastfeed. Med. 2006;1:253–262. doi: 10.1089/bfm.2006.1.253.
    1. Wight N., Marinelli K.A. ABM clinical protocol #1: Guidelines for glucose monitoring and treatment of hypoglycemia in breastfed neonates. Breastfeed. Med. 2006;1:178–184.
    1. De Rooy L., Johns A. Management of the vulnerable baby on the postnatal ward and transitional care unit. Early Hum. Dev. 2010;86:281–285. doi: 10.1016/j.earlhumdev.2010.05.004.
    1. Stewart C.E., Sage E.L., Reynolds P. Supporting ‘Baby Friendly’: A quality improvement initiative for the management of transitional neonatal hypoglycaemia. Arch. Dis. Child. Fetal Neonatal Ed. 2016;101:F344–F347. doi: 10.1136/archdischild-2015-308950.
    1. Barennes H., Valea I., Nagot N., Van de Perre P., Pussard E. Sublingual sugar administration as an alternative to intravenous dextrose administration to correct hypoglycemia among children in the tropics. Pediatrics. 2005;116:e648–e653. doi: 10.1542/peds.2004-2218.
    1. Women and Newborn Health Service . Neonatology Clinical Guidelines. King Edward Memorial/Princess Margaret Hospitals; Perth, Australia: 2006. Oral Sucrose for Procedural Pain Relief.
    1. Stevens B., Yamada J., Ohlsson A., Haliburton S., Shorkey A. Sucrose for analgesia in newborn infants undergoing painful procedures. Cochrane Database Syst. Rev. 2016 doi: 10.1002/14651858.CD001069.pub5.
    1. Taddio A., Shah V., Hancock R., Smith R.W., Stephens D., Atenafu E., Beyene J., Koren G., Stevens B., Katz J. Effectiveness of sucrose analgesia in newborns undergoing painful medical procedures. CMAJ. 2008;179:37–43. doi: 10.1503/cmaj.071734.
    1. Harding J.E., Hegarty J.E., Crowther C.A., Edlin R., Gamble G., Alsweiler J.M. Randomised trial of neonatal hypoglycaemia prevention with oral dextrose gel (hPOD): Study protocol. BMC Pediatr. 2015;15:120. doi: 10.1186/s12887-015-0440-6.

Source: PubMed

Sponsorzy i współpracownicy

Warunki medyczne

Interwencje lekowe

3
Subskrybuj