Outcomes of 40% oral dextrose gel for prevention of hypoglycemia in at-risk neonates
Keywords:
Neonatal hypoglycemia, Oral dextrose gel, At-risk neonatesAbstract
Background: Neonatal hypoglycemia is a common problem, especially in at-risk neonates. An innovative prevention protocol adding 40% oral dextrose gel, prepared by hospital pharmacies, was implemented to reduce the incidence of hypoglycemia.
Objectives: To determine the incidence of hypoglycemia at 1 hour of life in asymptomatic high-risk neonates receiving 40% oral dextrose gel according to the prevention protocol, identify factors associated with prevention failure, and compare the incidence of hypoglycemia before and after implementation of the oral dextrose gel protocol.
Methods: A prospective cohort study was conducted between April and December 2023, including 342 at-risk neonates with gestational age ≥ 35 weeks who received 40% oral dextrose gel after birth together with early feeding. The primary outcome was the incidence of hypoglycemia, and secondary outcomes were related clinical outcomes. Results were compared with 418 historical at-risk neonates before implementation of the oral dextrose gel protocol.
Results: Eleven at-risk neonates (3.2%) who received oral dextrose gel developed hypoglycemia, and four neonates (1.2%) required intravenous glucose therapy. Maternal insulin use was identified as a factor associated with prevention failure (p value 0.04). Compared with the historical control, the incidence of hypoglycemia (12.7%) and the requirement for intravenous glucose (12%) decreased significantly (p value < 0.001).
Conclusion: The implementation of 40% oral dextrose gel reduced the incidence of hypoglycemia and the requirement for intravenous glucose therapy. Maternal insulin use during pregnancy was the primary factor associated with prevention failure.
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