Abstract
Hypoglycemia is a major cause of morbidity and mortality among preterm infants and its management remains a challenge in resource limited settings. Use of dextrose infusion by the recommended infusion pumps is not feasible in our environment due to their high costs and yet the current use of mini dextrose boluses with syringes as adapted at Mulago national referral and tertiary teaching hospital has unknown efficacy in prevention of hypoglycemia. We determined the efficacy of dextrose infusions by burettes versus two hourly dextrose boluses in prevention of hypoglycemia among preterms admitted in the first 72 hours at Special Care Unit, Mulago Hospital. One hundred and forty preterms aged 0 to 24 hours of life were randomized to receive 10% IV dextrose either as mini boluses or by infusion using burettes in an open label clinical trial. Blood glucose was measured at 0, two hourly for next 6 hours, 6 hourly for next 12 hours and thereafter 12 hourly until end of 72 hours following admission. Primary end point was incidence of hypoglycemia (random blood sugar (RBS) < 2.6 mmol/l) which was expressed as relative risk (RR). Efficacy of the dextrose infusion was computed using 1-RR. From February 2012 to April 2012, 68 preterms in the bolus arm and 72 in the infusion arm were studied. Hypoglycemia was detected in 34% (48/140). The incidence of hypoglycemia in the bolus arm was 59% (40/68) compared to 11% (8/72) in the infusion arm (RR; 0.19, 95% CI; 0.09-0.37). Efficacy (1-RR) of infusion by burettes versus boluses in prevention of hypoglycemia among preterms was 0.81 (95% CI; 0.63-0.90). Continuous 10% dextrose infusion by burettes reduced the incidence of hypoglycemia by 81% in the first 72 hours of admission compared to two hourly 10% mini dextrose boluses among preterms admitted at Special Care Unit, Mulago Hospital. (ClinicalTrials.gov Identifier: NCT01688674).
Highlights
Prematurity and low birth weight contribute 29% of the total newborn deaths globally(1) and hypoglycemia is one of the major complications of prematurity
Of the 140 (54%) preterms who were enrolled into the study 68 were randomized into the mini bolus arm, and 72 into the infusion arm and analyzed respectively
The measure of efficacy was the incidence proportion of hypoglycemia in the two study groups, expressed as a relative risk. In this randomized clinical trial, we found that using 10% dextrose infusion by burettes reduced the incidence of hypoglycemia among preterms by 81% compared to dextrose boluses
Summary
Prematurity and low birth weight contribute 29% of the total newborn deaths globally(1) and hypoglycemia is one of the major complications of prematurity. The overall incidence has been reported to be 1 to 5 per 1000 live births and the risk is highest in preterm infants (2). We undertook an open label randomized clinical trial to assess whether IV 10% dextrose given as mini boluses compared to burette infusion had similar efficacy in prevention of hypoglycemia among preterm infants. Methods: One hundred and forty preterms aged 0 to 24 hours of life were randomized to receive 10% IV dextrose either as mini boluses or by infusion using burettes in an open label clinical trial. Conclusion: Continuous 10% dextrose infusion by burettes reduced the incidence of hypoglycemia by 81% in the first 72 hours of admission compared to two hourly 10% mini dextrose boluses among preterms admitted at Special Care Unit, Mulago Hospital.(ClinicalTrials.gov Identifier: NCT01688674) Keywords: Dextrose boluses, burette infusions, hypoglycemia
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