Treatment Of Neonatal Hypoglycemia Research Articles

Expressed breast milk and maternal expression of breast milk for the prevention and treatment of neonatal hypoglycemia: a systematic review and meta-analysis

BackgroundWorldwide, many guidelines recommend the use of expressed breast milk (EBM) and maternal expression of breast milk for the prevention and treatment of neonatal hypoglycemia. However, the impact of both practices on neonatal hypoglycemia is unclear. This study aims to determine the effectiveness of EBM and maternal expression of breast milk in preventing and treating neonatal hypoglycemia.MethodsWe registered our review in PROSPERO (CRD42022328072). We systematically reviewed five databases and four clinical trial registries to identify randomized controlled trials (RCT), non-randomized studies of intervention (NRSI), and cohort studies that compared infants who received EBM to infants who did not, and similar study designs that compared infants whose mothers expressed breast milk to infants whose mothers did not. Two independent reviewers carried out screening, data extraction, and quality assessment. The quality of included RCT, NRSI, and cohort studies were respectively assessed with the Cochrane Risk of Bias 2, Risk Of Bias In Non-randomised Studies—of Interventions, and the Newcastle–Ottawa Scale tools. Results from studies on EBM were synthesized separately from those on maternal expression of breast milk. Meta-analysis was undertaken using Revman 5.4. and fixed-effect models.ResultsNone of the ten included studies was specifically designed to determine the effect of EBM or maternal expression of breast milk on neonatal hypoglycemia. The effect of EBM on neonatal hypoglycemia was not estimable. There was no difference in the risk of hypoglycaemia among neonates whose mothers expressed breast milk compared to those whose mothers did not [RR (95%CI); one RCT: 0.92 (0.77, 1.10), high-certainty evidence; one cohort: 1.10 (0.74, 1.39), poor quality study].ConclusionsThere is insufficient evidence to determine the effectiveness of EBM for preventing or treating neonatal hypoglycemia. Limited data suggests maternal breast milk expression may not alter the risk of neonatal hypoglycemia. High-quality randomized controlled trials are needed to determine the effectiveness of EBM and maternal expression of breast milk for the prevention and treatment of neonatal hypoglycemia.

Protecting against brain damage by improving treatment in neonates with hypoglycaemia: ProBrain-D—a study protocol of a prospective longitudinal study

IntroductionAlthough neonatal hypoglycaemia is the most common metabolic problem in neonates, there is no standard guideline for screening. Additionally, treatment of neonatal hypoglycaemia and glucose administration thresholds are discussed controversially....

How Much Glucose Is in the Gel Used to Treat Neonatal Hypoglycemia?

ObjectiveTo compare glucose concentrations in three sections of individual tubes and among tubes of commercial oral glucose gels commonly used to treat neonatal hypoglycemia in the United States (Glutose 15 [Perrigo, Minneapolis, MN] and Insta-Glucose [Valeant Pharmaceuticals North America LLC, Bridgewater, NJ]). DesignA quantitative laboratory study. MethodsWe measured glucose concentrations in aliquots taken from the top, middle, and bottom sections of three different lots and in whole tubes from different lots of Glutose 15 and Insta-Glucose. We measured the glucose content in the gel using hexokinase and glucose-6-phosphate dehydrogenase enzymes on the Siemens ADVIA 1800 analyzer (Siemens Healthcare Diagnostics, Inc., Tarrytown, NY). ResultsThe percent difference observed among the three sections of the Glutose 15 tubes was 12.3% to 53.8%. The difference among the three sections of the Insta-Glucose tubes was 40.7% to 79.6%. The concentration of glucose gel is labeled as 40%, but the actual concentration in aliquots of Glutose 15 ranged from 39.64% to 70.96%. The actual concentration in aliquots of Insta-Glucose ranged from 16.45% to 27.47%. The difference in the concentration of glucose among three lots of whole tubes of Glutose 15 was 1.6%, and the difference in concentration among three lots of whole tubes of Insta-Glucose was 8.8%. In Glutose 15, the concentration ranged from 48.3% to 49.1%, and Insta-Glucose, the concentration ranged from 17.2% to 18.8%. ConclusionGlucose was not uniformly distributed within tubes of Glutose 15 and Insta-Glucose, and this may account for variable results on the efficacy of oral glucose gel as a treatment for neonatal hypoglycemia.

Effect of prophylactic dextrose gel on the neonatal gut microbiome

ObjectiveTo determine the effect of prophylactic dextrose gel on the infant gut microbiome.DesignObservational cohort study nested in a randomised trial.SettingThree maternity hospitals in New Zealand.PatientsInfants at risk of neonatal hypoglycaemia...

Decreasing the Number of NICU Admissions Related to Hypoglycemia

Neonatal hypoglycemia affects 15%–30% of newborns. Treatment for neonatal hypoglycemia is based on hospital policy and guidelines. Many newborns who have blood glucose levels that fall below the recommended hospital guidelines are admitted to the NICU for further management. This leads to maternal and newborn separation, maternal anxiety, and difficulty in adherence to breastfeeding. There are modifiable factors that can contribute to newborn hypoglycemia. This includes neonatal hypothermia, delayed newborn feeding, and undiagnosed maternal sepsis.

Effects of neonatal nutrition interventions on neonatal mortality and child health and development outcomes: A systematic review.

Effects of neonatal nutrition interventions on neonatal mortality and child health and development outcomes: A systematic review.

Study of glucose levels in newborn with reference to hypoglycemia

Background: Hypoglycemia is one of the common metabolic problems in neonatal medicine. Early diagnosis and treatment of neonatal hypoglycemia is important as many studies found that, hypoglycaemic episodes in neonates lead to neurodevelopmental and physical growth deficits. In this study, blood glucose levels at different time points were assessed and the influence of maternal blood glucose, mode of delivery, gestational age on neonatal blood glucose levels were studied.Methods: Blood glucose levels were low at 0 and 6th hour and maximum at 24th hour. The blood glucose levels ranged from 27 mg/dl to 140 mg/dl. Neonates with high maternal blood glucose were hypoglycaemic, showing a negative correlation.Results: The mean blood glucose levels were low in pre-term and post term babies compared to term and the range was wide in pre-term and term babies compared to post-term. The mean blood glucose levels were high and range was wide in babies delivered vaginally at all the time points compared to the babies delivered by LSCS. 17% babies were hypoglycaemic at birth but none of them had signs. The major signs noted were jitteriness (88%), high cry (88%), lethargy (55%), tremors (55%), limpness (22%), apathy (22%), weak cry (11%) and poor feeding (11%).Conclusions: 0 and 6th hour are the vulnerable time points for hypoglycaemia. Neonates with high maternal blood glucose, pre-term, post-term and babies delivered by LSCS were more prone for hypoglycaemia requiring blood glucose monitoring. There is a wide variation in signs of hypoglycaemia and babies showing signs require monitoring.

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.

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...

Incidence and risk factors of neonatal hypoglycemia after ritodrine therapy in premature labor: a retrospective cohort study

BackgroundRitodrine hydrochloride (RD), a β2-adrenergic agonist, is widely used as a tocolytic medication to suppress premature labor, but can cause neonatal hypoglycemia, a potentially severe side effect. We examined the incidence and risk factors of neonatal hypoglycemia following maternal intravenous administration of RD.MethodsThis was a retrospective study of neonates, who had birth weight of ≥2000 g and were delivered at 36 weeks gestation or later in Kanazawa University Hospital from August 2013 to July 2016. We defined neonatal hypoglycemia as blood glucose level < 50 mg/dL. Neonates who were delivered without maternal intravenous RD or who were delivered 8 days or more after stopping maternal RD or who received oral RD were defined as the RD non-administration group, while those delivered within 7 days after stopping maternal RD were defined as the RD intravenous administration group. We examined the incidence and risk factors of RD-induced neonatal hypoglycemia by comparing these two groups.ResultsWe enrolled 603 neonates in this study; 504 (83.6%) showed no neonatal hypoglycemia, while 99 (16.4%) exhibited neonatal hypoglycemia. The incidence of neonatal hypoglycemia was significantly higher (61.7%; 58/94) in the RD intravenous administration group than in the RD non-administration group (8.1%; 41/509) (p < 0.001). Binomial logistic regression analysis in the RD intravenous administration group showed that maternal age over 35 years (AOR: 3.385; 95% CI, 1.082–10.588, p = 0.036) and the interval to delivery from stopping intravenous administration of RD (AOR: 0.974; 95% CI, 0.953–0.996, p = 0.020) were independent factors associated with neonatal hypoglycemia. The cut-off value of the interval to predict the incidence of neonatal hypoglycemia was about 6 h (sensitivity 82.8%, specificity 63.9%).ConclusionsThe incidence of neonatal hypoglycemia was significantly increased by maternal intravenous administration of RD. We newly identified maternal age (over 35 years) and the interval to delivery from stopping intravenous administration of RD (within 6 h) as independent risk factors for neonatal hypoglycemia following maternal intravenous administration of RD. In cases with these risk factors, careful blood glucose monitoring is recommended for early detection and treatment of neonatal hypoglycemia.

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.

Is Glucose Gel an Effective Treatment for Neonatal Hypoglycemia?

Is Glucose Gel an Effective Treatment for Neonatal Hypoglycemia?

Proportion of Abnormal Glucose Values and Perinatal Outcome [13J

INTRODUCTION: Practical targets for glycemic control are unclear. This study examines associations between different proportions of abnormal self-monitored blood glucose (SMBG) values and adverse perinatal outcomes. METHODS: We conducted a retrospective cohort study of women undergoing SMBG between 1/1/2011-12/31/2016. Four weeks of SMBG values initiated before 32 weeks with at least 50% of expected values present were required. Women with type 1 diabetes or major congenital anomalies were excluded. The primary outcome was a composite of stillbirth, neonatal death, cesarean for arrest, shoulder dystocia, birth injury, new hypertensive disorder, birth weight &gt;90% (LGA), or treatment for neonatal hypoglycemia. The primary exposure was the total percent abnormal SMBG values, examined by degree of abnormality: &lt;25% (tight), &lt;33% (moderate), or &lt;50% (loose) abnormal. RESULTS: 120 women met inclusion criteria of whom 47.9% had gestational diabetes (GDM) and 52.1% had type 2 diabetes. Overall, 29.4% had tight control, 37.0% had moderate control, and 33.6% had loose control. Women with tight control were less likely to experience the primary outcome (34.3% vs 69.4%, RR 0.49, 95%CI 0.31-0.80), LGA infants (14.3% vs 34.5%, RR 0.41, 95% CI 0.17-0.98), or neonatal hypoglycemia (11.4% vs 34.1%, RR 0.34, 95%CI 0.13-0.88) than women without tight control. After adjusting for age, parity, and diabetes type, both moderate and tight control were associated with a reduced odds for the primary outcome, however loose control was not. CONCLUSION: Keeping SMBG to less than 33% abnormal is associated with a reduced risk of adverse perinatal outcomes. These data may help clinicians set targets for glycemic control.

Oral Dextrose Gel Lowers Cost of Care for Neonatal Hypoglycemia

Oral dextrose gel is gaining acceptance as an effective treatment for neonatal hypoglycemia (blood glucose <47 mg/dL). To compare its cost with

Dextrose Gel—First‐Line Treatment for Neonatal Hypoglycemia in a Special Care Nursery

Dextrose Gel—First‐Line Treatment for Neonatal Hypoglycemia in a Special Care Nursery

Midwife or doctor local opinion leader to implement a national guideline in babies on postnatal wards (DesIGN): protocol of a cluster-randomised, blinded, controlled trial

IntroductionNeonatal hypoglycaemia is a common condition that can cause developmental delay. Treatment of neonatal hypoglycaemia with oral dextrose gel has been shown to reverse hypoglycaemia and reduce admissions to neonatal...

Neurodevelopmental Outcome in Neonates with Hypoglycaemia and Associated Risk Factors: A Follow up Study

Introduction: Neonatal hypoglycemia is a common problem requiring medical attention in newborn and a leading cause of preventable brain damage, physical and mental handicap and early deaths among infants. Objective: To study the prevalence of neuro-developmental abnormalities and risk factors associated with poor outcome. Materials and methods: This was a prospective study on 39 neonates with hypoglycemia who were admitted to neonatal intensive care unit (NICU) from November 2015 to December 2016 and were fulfilling the inclusion criteria. Gestational age at birth, sex, birth weight, age of presentation, duration and severity of hypoglycaemia were noted in all neonates. Neuro-developmental assessment was done on follow up at 3 and 6 months by Denver developmental screening test 2 (DDST 2) method. Results: Out of 39 neonates, the prevalence of abnormal neurodevelopmental outcome according to DDST II method was 71.7% [n=28] at 3 months and 66.6% [n=26] at 6 months. Factors such as early onset, symptoms, longer duration of hypoglycemia, minimum blood glucose level, number of readings <25 mg/dl and maximum glucose infusion rate (GIR) were significantly associated with adverse outcome. Conclusion: Neonatal hypoglycemia is associated with long-term neurodevelopmental handicaps. Mental and psychomotor developmental indices of the children who suffered from hypoglycemia during new-born period are significantly low. Hence, early diagnosis and treatment of neonatal hypoglycemia is mandatory to prevent neurological sequelae.

A Perspective on Neurological Aspects of Neonatal Hypoglycaemia

Cerebral metabolism is mainly dependent upon glucose utilization. In newborn infants, low blood glucose levels cause to neuronal and glial cell death, and hence associated with long-term neuro­developmental handicaps. Occipital and parietal lobes are most severely affected regions of the brain on imaging techniques in infants suffered from brain damage as a result of neonatal hypoglycaemia. On neurodevelopment follow up, the mental and psychomotor developmental indexes of the children who suffered from hypoglycaemia during newborn period are significantly low. Hence, early diagnosis and treatment of neonatal hypoglycaemia is mandatory to prevent the long-term neurological sequelae.

Neurologic outcome in patients with MRI pattern of damage typical for neonatal hypoglycemia

Imaging features of infants who suffered from brain damage as a result of neonatal hypoglycemia were shown to have similar patterns, and to affect the parietal and occipital lobes most severely. Long term follow up regarding clinical outcome of patients with neonatal hypoglycemia and this pattern of damage are limited. We reviewed the medical records of 24 patients with typical neuroimaging features seen following neonatal hypoglycemia; we report neurological outcome in 13 of them who have documented hypoglycemia. Except for one patient, all patients had prenatal and perinatal problems including prematurity, perinatal hypoxia, intrauterine growth retardation, sepsis, indirect hyperbilirubinemia. All but one patient had symptomatic partial epilepsy, five of them were medically intractable. Other neurologic problems included developmental delays, learning and behavior problems, hyperactivity and attention difficulties, autistic features, microcephaly and cortical blindness. We conclude that early diagnosis and treatment of neonatal hypoglycemia is crucial to prevent future neurological sequelae, especially in patients with additional perinatal risk factors.

Neonatal hypoglycemia, Part I: Background and definition.

Hypoglycemia in the neonate remains a common problem. The association of low blood glucose concentrations and abnormal development has prompted extensive research into the anticipation, evaluation, and treatment of neonatal hypoglycemia. Glucose homeostasis in the fetus and neonate is a developmentally regulated dynamic process involving a number of intricate physiologic mechanisms. In addition, the determination of glucose concentrations is dependent upon both the type of tissue analyzed and the limitations of the specific method employed. The complexity of glucose metabolism makes it difficult to precisely define "normal" and "abnormal" glucose levels in preterm and term neonates.