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Pediatrics Xagena

Dextrose gel for first-line treatment to manage hypoglycaemia in late preterm and term babies in the first 48 h after birth


Neonatal hypoglycaemia is common, and a preventable cause of brain damage. Dextrose gel is used to reverse hypoglycaemia in individuals with diabetes; however, little evidence exists for its use in babies.
A study has assessed whether treatment with Dextrose gel was more effective than feeding alone for reversal of neonatal hypoglycaemia in at-risk babies.

Researchers undertook a randomised, double-blind, placebo-controlled trial at a tertiary centre in New Zealand during the period 2008-2010.
Babies aged 35-42 weeks' gestation, younger than 48-h-old, and at risk of hypoglycaemia were randomly assigned ( 1:1 ) to 40% Dextrose gel 200 mg/kg or placebo gel.
Randomisation was stratified by maternal diabetes and birthweight.

The primary outcome was treatment failure, defined as a blood glucose concentration of less than 2.6 mmol/L after two treatment attempts.
Analysis was by intention to treat.

Of 514 enrolled babies, 242 ( 47% ) became hypoglycaemic and were randomised. Five babies were randomised in error, leaving 237 for analysis: 118 ( 50% ) in the Dextrose group and 119 ( 50% ) in the placebo group.

Dextrose gel reduced the frequency of treatment failure compared with placebo ( 16 [ 14% ] vs 29 [ 24% ]; relative risk 0.57; p=0.04 ).

No serious adverse events was noted. Three ( 3% ) babies in the placebo group each had one blood glucose concentration of 0.9 mmol/L. No other adverse events took place.

In conclusion, the treatment with Dextrose gel is inexpensive and simple to administer. Dextrose gel should be considered for first-line treatment to manage hypoglycaemia in late preterm and term babies in the first 48 h after birth. ( Xagena )

Harris DL et al, The Lancet 2013; 382: 2077-2083

XagenaMedicine_2013



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