Oral Dextrose Gel to treat neonatal hypoglycaemia: Clinical Practice Guidelines
Evidence-based recommendations to guide decision making in clinical practice in New Zealand.
Neonatal hypoglycaemia is common in the first few days after birth, with 30% of New Zealand babies born at risk (infants of diabetic mothers, preterm or small or large for gestational age) (Nagy 2012).
Standard management of babies in whom low glucose concentrations are detected often involves the use of formula, which can reduce breastfeeding rates (Blomquist 1994), or admission to the Special Care Baby Unit (SCBU)/Neonatal Intensive Care Unit (NICU) for intravenous dextrose (Agrawal 2000), thereby separating the mother and baby and potentially delaying the establishment of breast feeding.
The use of oral dextrose gel for the treatment of neonatal hypoglycaemia has been shown to be effective in reversing hypoglycaemia (Harris 2013) and is increasingly being used in New Zealand maternity hospitals.
References
Agrawal RK, Lui K, Gupta JM. Neonatal hypoglycaemia in infants of diabetic mothers. Journal of Paediatrics and Child Health 2000;36:354-356.
Blomquist HK, Jonsbo F, Serenius F, Persson LA. Supplementary feeding in the maternity ward shortens the duration of breast feeding. Acta Paediatrica Scandinavica 1994;83:1122-1126.
Nagy T, Hegarty JE, Alsweiler JM. Audit of neonatal hypoglycaemia screening in at-risk babies. Paediatric Society of New Zealand 2012;Palmerston North.
Harris DI, Weston PJ, Signal M, Chase JG, Harding JE. Dextrose gel for neonatal hypoglycaaemia (the Sugar Babies Study); a randomised, double-blind, placebo-controlled trial. The Lancet 2013;382(9910):2077-2083.
There was a need for a national clinical practice guideline to provide evidence based recommendations to guide decision making in clinical practice, and to provide consistency in practice across New Zealand in the use of oral dextrose gel to treat neonatal hypoglycaemia.
Aim of this Clinical Practice Guideline
To provide evidence based recommendations on the use of oral dextrose gel to treat neonatal hypoglycaemia.
Target Audience
- Health professionals who care for pregnant women where the baby is at increased risk of neonatal hypoglycaemia due to factors such as maternal diabetes, growth restriction, macrosomia and preterm birth;
- Health professionals caring for newborns with neonatal hypoglycaemia;
- Pregnant women, their partners and whanau;
- Policy makers in maternity and neonatal care.
Scope of the Clinical Practice Guidelines
To examine the evidence for giving babies with hypoglycaemia oral dextrose gel, for the purpose of improving health outcomes for the baby.
The scope includes the use of oral dextrose gel in babies diagnosed with neonatal hypoglycaemia. This Clinical Practice Guideline did not cover the screening criteria or diagnosis of neonatal hypoglycaemia or the use of dextrose gel given to prevent the development of hypoglycaemia.
