Dextrose Gel Research Articles

Effect of Synthetic Vitamin A and Probiotics Supplementation for Prevention of Morbidity and Mortality during the Neonatal Period. A Systematic Review and Meta-Analysis of Studies from Low- and Middle-Income Countries.

Background: Suboptimal nutritional status of a newborn is a risk factor for short- and long-term morbidity and mortality. The objectives of this review were to assess the efficacy and effectiveness of neonatal synthetic vitamin A supplementation, dextrose gel and probiotic supplementation for prevention of morbidity and mortality during infancy in low and middle-income countries. Methods: We included randomized trials. Primary outcome was all-cause mortality. We conducted electronic searches on multiple databases. Data were meta-analyzed to obtain relative risk (RR) and 95% confidence interval (CI). Studies for vitamin A and Probiotics were analyzed separately. No studies were found for dextrose gel supplementation during neonatal period. The overall rating of evidence was determined by Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Results: Sixteen studies assessed the effect of vitamin A supplementation during the neonatal period. Based on pooled data from community-based studies only, there was no significant effect of vitamin A on all-cause mortality at age 1 month (RR 0.99, 95% CI 0.90, 1.08), 6 months (RR 0.98; 95% CI 0.89–1.08) and 12 months (RR 1.04, 95% CI 0.94, 1.14) but increased risk of bulging fontanelle (RR 1.53, 95% CI 1.12, 2.09). The overall quality of evidence was high for the above outcomes. Thirty-three studies assessed the effect of probiotic supplementation during the neonatal period and were mostly conducted in the hospital setting. Probiotics reduced the risk of all-cause mortality (RR 0.80, 95% CI 0.66, 0.96), necrotizing enterocolitis (RR 0.46, 95% CI 0.35, 0.59) and neonatal sepsis (RR 0.78, 95% CI 0.70, 0.86). The grade ratings for the above three outcomes were high. Conclusions: Vitamin A supplementation during the neonatal period does not reduce all-cause neonatal or infant mortality in low and middle-income countries in the community setting. Probiotic supplementation during the neonatal period seems to reduce all-cause mortality, NEC, and sepsis in babies born low birth weight and/or preterm in the hospital setting.

Translation into Practice: Dextrose Gel Treatment for Neonatal Hypoglycemia to Reduce NICU Admissions and Increase Breastfeeding Exclusivity.

Oral dextrose gel is an evidence-based treatment that has been shown to reduce NICU admissions and support exclusive breastfeeding. We summarize a knowledge translation project to introduce dextrose 40 percent oral gel to treat hypoglycemia or hyperglycemia. Implementation took place during the months of May, June, and July 2017. Through chart audit, rates for NICU admissions and exclusive breastfeeding were measured for a three-month period before implementation and the three-month period after implementation.There were 234 doses indicated, 128 doses given, 93 doses missed, and 13 doses declined by parents in the first three months of implementation. Admission rates to the NICU for the groups audited were 13 percent in 2016 and 6 percent in 2017.Principles of knowledge translation were used to successfully introduce this change. Centers providing maternal newborn care should consider similar projects to enable introduction.

Galenic Preparation of 40% Dextrose Gel: A New Approach to the Management of Neonatal Hypoglycemia.

Galenic Preparation of 40% Dextrose Gel: A New Approach to the Management of Neonatal Hypoglycemia.

Effects of Dextrose Gel in Newborns at Risk for Neonatal Hypoglycemia in a Baby-Friendly Hospital

ObjectiveTo describe the effects of the introduction of dextrose gel to the neonatal hypoglycemia (NH) protocol on exclusive breastfeeding rates at discharge and NICU admission rates among clinically well newborns born at 35 weeks gestation or greater who were at risk for NH in a Baby-Friendly hospital. DesignQuasi-experimental, pre- and postintervention. SettingA suburban, Baby-Friendly hospital with approximately 2,000 births annually. ParticipantsClinically well newborns born at 35 weeks gestation or greater at risk for NH who were admitted to the mother–baby unit. MethodsWe compared 198 newborns at risk for NH born in the 6-month period before the introduction of dextrose gel (November 15, 2016, through May 14, 2017) versus 203 newborns born in the 6-month period after the introduction (May 15, 2017, through November 14, 2017). In the preintervention group, the NH protocol included blood glucose monitoring, prolonged skin-to-skin contact, feeding, and dextrose administered intravenously. In the postintervention group, oral dextrose gel was added to the NH protocol. ResultsWe found no differences in maternal or newborn characteristics between the pre- and postintervention groups. Dextrose gel was given to 50 newborns (approximately 25%) of 203 in the postintervention group. The proportion of newborns who were exclusively breastfed at discharge was similar between groups (56.6% of 198 vs. 59.1% of 203, p = .62), as were the NICU admission rates for hypoglycemia (2.5% of 198 vs. 1.5% of 203, p = .50). ConclusionsIn a suburban Baby-Friendly hospital, introduction of dextrose gel into the NH protocol had no significant effect on exclusive breastfeeding at discharge or NICU admission rates.

Can Oral Dextrose Gel Reduce the Need for Dextrose Infusion for Neonatal Hypoglycaemia?

Can Oral Dextrose Gel Reduce the Need for Dextrose Infusion for Neonatal Hypoglycaemia?

Swedish national guideline for prevention and treatment of neonatal hypoglycaemia in newborn infants with gestational age ≥35weeks.

Postnatal hypoglycaemia in newborn infants remains an important clinical problem where prolonged periods of hypoglycaemia are associated with poor neurodevelopmental outcome. The aim was to develop an evidence-based national guideline with the purpose to optimise prevention, diagnosis and treatment of hypoglycaemia in newborn infants with a gestational age ≥35+0weeks. A PubMed search-based literature review was used to find actual and applicable evidence for all incorporated recommendations. The GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach was used for grading the evidence of the recommendations. Recommendations for the prevention of neonatal hypoglycaemia were extended and updated, focusing on promotion of breastfeeding as one prevention strategy. Oral dextrose gel as a novel supplemental therapy was incorporated in the treatment protocol. A new threshold-based screening and treatment protocol presented as a flow chart was developed. An updated and evidence-based national guideline for screening and treatment of neonatal hypoglycaemia will support standardised regimes, which may prevent hypoglycaemia and the risk for hypoglycaemia-related long-term sequelae.

Evaluating the effects of a neonatal hypoglycemia bundle on NICU admission and exclusive breastfeeding.

Early feeding, skin-to-skin contact, and dextrose gel have been independently shown to promote breastfeeding and decrease NICU admission for neonatal hypoglycemia. We combined these interventions to decrease NICU admissions for asymptomatic hypoglycemia and increase exclusive breastfeeding rates. The IHI Model for Improvement was used to design a bundle including feeding within 1 h of birth, 1 h of uninterrupted skin-to-skin within 2 h of birth, and administration of buccal 40% dextrose gel for hypoglycemic infants. Utilization of dextrose gel was 94% following implementation. There were no trends in exclusive breastfeeding at discharge or NICU admissions for asymptomatic hypoglycemia. Post hoc multivariate analysis identified cesarean delivery as an independent risk factor for compliance failure and failure of exclusive breastfeeding but not for NICU admission. Despite high compliance with dextrose gel utilization, there was no change in exclusive breastfeeding at discharge or NICU admission rates for asymptomatic hypoglycemia.

Implementation of a Neonatal Hypoglycemia Bundle in a Military Treatment Facility

Objective/Aim: Incorporate a neonatal hypoglycemia prevention bundle into an existing hypoglycemia algorithm and assess effects on NICU admission and breastfeeding success. Background: Transient neonatal hypoglycemia affects up to 15% of newborn deliveries and is associated with significant risk of NICU admission, geographical separation from parents, and interruption of breastfeeding goals. Early initiation of feeds, early skin-to-skin contact, and dextrose gel supplementation have all been independently shown to promote exclusive breastfeeding …

Impact of a Neonatal Hypoglycemia Bundle on NICU Admission and Breastfeeding Success

Objective/Aim: To incorporate a neonatal hypoglycemia prevention bundle into preexisting newborn hypoglycemia algorithms and assess effects on exclusive breastfeeding success and NICU admission rates. Background: Transient neonatal hypoglycemia affects up to 15% of newborns and is associated with an increased risk of NICU admission, geographical separation from parents, and interruption of breastfeeding goals. Early initiation of feeds, early skin-to-skin contact, and dextrose gel supplementation have all …

Factors influencing glycaemic stability after neonatal hypoglycaemia and relationship to neurodevelopmental outcome

Higher and unstable glucose concentrations in the first 48 hours in neonates at risk of hypoglycaemia have been associated with neurosensory impairment. It is unclear what defines and contributes to instability. This was a prospective study of term and late preterm babies (N = 139) born at risk of neonatal hypoglycaemia who had interstitial glucose (IG) monitoring and ≥1 hypoglycaemic episode <48 hours after birth (blood glucose concentration <2.6 mmol/l [<47 mg/dl]). For 6-hour epochs after each hypoglycaemic episode, masked IG parameters (time to reach maximum IG concentration [hours]; range, average, maximum and minimum IG concentrations; proportion of IG measurements outside the central band of 3–4 mmol/l [54–72 md/dl]; and total duration [hours] of IG concentrations <2.6 mmol/l) were analysed in tertiles and related to: (i) glycaemic instability in the first 48 hours (defined as the proportion of blood glucose concentrations outside the central band in the first 48 hours); (ii) risk factors and treatment for each episode; and (iii) risk of neurosensory impairment at 4.5 years, or at 2 years if a child was not seen at 4.5 years. Glycaemic instability in the first 48 hours was related to IG instability after hypoglycaemia. Risk factors for hypoglycaemia were not related to IG parameters. Treatment with intravenous dextrose was associated with higher IG maximum and range, and lower minimum compared to treatment with dextrose gel plus breast milk, breast milk alone or formula alone. The risk of neurosensory impairment was increased with both shorter and longer time to reach maximum epoch IG (P = 0.04; lower tertile [0.4–2.2 hours] vs middle [2.3–4.2 hours] OR 3.10 [95% CI 1.03; 9.38]; higher tertile [4.3–6.0 hours] vs middle OR 3.07; [95% CI 1.01; 9.24]). Glycaemic response to hypoglycaemia contributes to overall glycaemic instability in newborns and is influenced by treatment. Slow or rapid recovery of hypoglycaemia appears to be associated with neurosensory impairment.

Neonatal Hypoglycemia and the Effects of Dextrose Gel

In 2011, the American Academy of Pediatrics published guidelines for the management of neonatal hypoglycemia. These were guidelines only, because no absolute blood glucose level has been associated with adverse neonatal outcomes. The implementation of these guidelines caused an increased number of admissions to the NICU for neonates with hypoglycemia in the institution. NICU admissions are costly, stressful to the newborn, disrupt parent–newborn bonding, and can negatively impact exclusive breastfeeding rates. In the Sugar Babies Study, the use of dextrose gel was reviewed for treatment of neonatal hypoglycemia in neonates 35 weeks or older gestational age and 48 hours or less of life. The study found a decrease in NICU admission rates, which provided more time for parent–infant bonding, and an increase in 2-week postbirth breastfeeding rates. A new hypoglycemia algorithm would be developed, including the administration of dextrose gel. Dextrose gel would be given to neonates with blood glucose levels less than 45 mg/dl, followed by a feeding of either breast milk or formula. Implementation was preceded by a vigorous educational intervention targeted to reach 85% of the nursing staff. Nurses were given a folder of materials, including a review of how to perform a heel stick; the new hypoglycemia algorithm; the procedure for dextrose administration; and the nursing policy and procedure for hypoglycemia. A demonstration was also provided for the disbursement and administration of dextrose gel. A physician’s order for dextrose gel was added to the Computerized Physician Order Entry (CPOE) system. The dextrose gel was also added to the medication delivery system. Implementation went smoothly, and an immediate effect was noted. Although we did not see a 73% decrease in NICU admissions, as noted in some of the literature, a significant decrease in NICU admissions occurred, with a concomitant improvement of exclusive breastfeeding rates. Dextrose gel administration is a viable alternative to feeding alone for neonates with hypoglycemia, with the results of a reduction in NICU admissions and improvement in exclusive breastfeeding rates. Perinatal nurses can have a significant impact on the NICU admission rates of neonates with hypoglycemia through the administration of dextrose gel in addition to breast milk or formula feeding.

Reduction in NICU Admissions With the Use of Oral Dextrose Gel

Reduction in NICU Admissions With the Use of Oral Dextrose Gel

Incorporating dextrose gel and feeding in the treatment of neonatal hypoglycaemia

ObjectivesTo determine the impact of incorporating dextrose gel in the treatment of neonatal hypoglycaemia (NH) and the role of feeding type in NH outcomes.Study designWe conducted a retrospective analysis of...

First aid glucose administration routes for symptomatic hypoglycaemia.

First aid glucose administration routes for symptomatic hypoglycaemia.

First aid glucose administration routes for symptomatic hypoglycaemia

First aid glucose administration routes for symptomatic hypoglycaemia

Dextrose gels for neonatal transitional hypoglycemia: What are we giving our babies?

Transitional hypoglycemia is common in at-risk newborns, frequently resulting in therapeutic interference with bonding and breastfeeding; 40% dextrose gel massaged to the buccal mucosa has been shown to decrease hypoglycemia <2.6 mmol/L and NICU admissions. However, in the absence of a newborn-specific product, over-the-counter diabetes-care products with poorly documented composition are being used for neonates. We analyzed the carbohydrate content, and compared composition of the two commercially available gels in Canada, Dex4 and Insta-Glucose. We found that the glucose concentrations were significantly different from the expected 40% glucose, and that they contain artificial colorants, flavours and preservatives. In addition, we observed inconsistent concentration differences within each tube when aliquotes from the top, middle, or bottom were measured. There is a need for a custom made neonatal dextrose gel dispensed in unit dose vials, with a standardized concentration of glucose, and without chemical substances one would generally not recommend administering to newly born infants.

Oral dextrose gel to treat neonatal hypoglycaemia: Clinician survey.

To determine the use of oral dextrose gel to treat neonatal hypoglycaemia in New Zealand (NZ), to identify barriers and enablers to the implementation of the guideline and to determine if there is variation in management between clinical disciplines caring for at-risk babies. An online survey was distributed to clinicians (including doctors, midwives and nurses) caring for babies with neonatal hypoglycaemia via stakeholders and maternity hospitals. A total of 251 clinicians from all 20 District Health Boards (DHBs) completed the survey. Of the responding clinicians, 148 (59%) from 15 (75%) DHBs reported oral dextrose gel use in their hospital, and of these, 129 (87%) reported a local guideline. In 12 of 15 (80%) DHBs, oral dextrose gel could be prescribed by midwives. For a clinical scenario of a baby with neonatal hypoglycaemia, doctors were more likely to prescribe oral dextrose gel than midwives (odds ratio (95% confidence interval), 2.9 (2.2-3.8), P < 0.0001). Of 32 possible combinations of treatment options for this scenario, 31 were selected by one or more clinicians. A guideline was perceived to be the most useful enabler, and availability of oral dextrose gel was seen as the most important barrier. Oral dextrose gel is widely used to treat neonatal hypoglycaemia in NZ. Increasing availability of dextrose gel and the clinical practice guideline are likely to further increase the use of oral dextrose gel.

What Happens to Blood Glucose Concentrations After Oral Treatment for Neonatal Hypoglycemia

Objective To determine the change in blood glucose concentration after oral treatment of infants with hypoglycemia in the first 48 hours after birth. Study design We analyzed data from 227 infants with hypoglycemia (blood glucose Results The overall mean increase in blood glucose concentration was 11.7 mg/dL (95% CI 10.4-12.8). The increase was greater after buccal dextrose gel than after placebo gel (+3.0 mg/dL; 95% CI 0.7-5.3; P = .01) and greater after infant formula than after other feedings (+3.8 mg/dL; 95% CI 0.8-6.7; P = .01). The increase in blood glucose concentration was not affected by breast feeding (+2.0 mg/dL; 95% CI −0.3 to 44.2; P = .09) or expressed breast milk (−1.4 mg/dL; 95% CI −3.7 to 0.9; P = .25). However, breast feeding was associated with reduced requirement for repeat gel treatment (OR = 0.52; 95% CI 0.28-0.94; P = .03). Conclusions Treatment of infants with hypoglycemia with dextrose gel or formula is associated with increased blood glucose concentration and breast feeding with reduced need for further treatment. Dextrose gel and breast feeding should be considered for first-line oral treatment of infants with hypoglycemia.

"Validation Study of: The Effect of Delayed Newborn Bath and Oral Dextrose Gel for Neonatal Hypoglycemia on Improving In-Hospital Exclusive Breastfeeding Rates"

"Validation Study of: The Effect of Delayed Newborn Bath and Oral Dextrose Gel for Neonatal Hypoglycemia on Improving In-Hospital Exclusive Breastfeeding Rates"

Evaluation of Dextrose Gel Administration to Infants with Asymptomatic Neonatal Hypoglycemia: A Single Center Experience

Purpose: We recently implemented a clinical practice guideline for asymptomatic neonatal hypoglycemia that includes use of dextrose gel. Following this change in practice, we sought to identify characteristics of infants at risk for needing two dextrose gels or intravenous fluids (IVF) containing dextrose. We also compared infants’ response to gel administration by feeding group. Methods: Any infant who received dextrose gel within the first 48 hours following birth over a 13 month period of time (January 2016-January 2017) at a large academic medical center was included in our evaluation. Participant characteristics were stratified by types of intervention received (received gel …