Cost Analysis of Treating Neonatal Hypoglycemia with Dextrose Gel

Glasgow, Matthew J.; Harding, Jane E.; Edlin, Richard; Alsweiler, Jane; Chase, J.G.; Harris, Deborah L; Thompson, Benjamin; Wouldes, Trecia; Ansell, Juliet; Jaquiery, Anne; Jones, Kelly; Martin, Sapphire; McQuoid, Christina; Rogers, Jenny; Stewart, Heather; Tottman, Anna C; Williamson, Kate D.; Campbell, Ellen; Bevan, Coila; Crawford, Tineke J; Fredell, Kelly; Sommers, Kate; Hahnhaussen, Claire; Hossin, Safayet; Frost, Karen; McKnight, G. Tipton; Paynter, John; Wilson, Jessica; Young, R. T.; Gsell, Anna C.; Brosnahan, Jessica; Timmings, Anna; Nair, Arun; Wallace, Alexandra; Weston, Phil J; Compte, Aaron Le; Signal, Matthew; Austin, Nicola; Armishaw, Jeremy; Webster, Nicola; Haslam, Ross; Ashwood, Pat; Doyle, Lex W.; Callanan, Kate; Wright, Ian; Feldman, Heidi M.; Hay, William W.; Wilson, Darrell; Hess, Robert M.

doi:10.1016/j.jpeds.2018.02.036

Cited by 35 publications

(16 citation statements)

References 15 publications

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“…Although in our study we did not directly perform a cost analysis, we observed the results of similar studies in literature [23] and we can assume that a reduced number of NICU admission, less iv treatment and a shorter length of hospitalization, make dextrose oral gel a less costly option for the management of neonatal asymptomatic hypoglycemia.…”

Section: Discussionsupporting

confidence: 50%

Management of Asymptomatic Hypoglycemia With Dextrose Oral Gel at 40% in Near Term at-risk Infants to Reduce Intensive Care Need and Promote Breastfeeding

Meneghin¹,

Manzalini²,

Acunzo³

et al. 2021

Preprint

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Background: Neonatal hypoglycemia is a common disorder especially in at-risk infants and it can be associated with poor long-term neurological outcomes. Several therapeutic interventions are suggested, from the implementation of breastfeeding to the glucose intravenous administration. Oral dextrose gel massaged into the infant’s inner cheek is a recent treatment option of asymptomatic hypoglycemia, after which oral feeding is encouraged. This approach seems to reduce the admission of infants to neonatal intensive care unit (NICU) so favouring maternal bonding and breastfeeding success at discharge. Methods: In our unit we recently implemented the protocol for the management of asymptomatic hypoglycemia with the introduction of dextrose oral gel at 40%. Therefore we compared two cohorts of near term at-risk infants with asymptomatic hypoglycemia: a historical group managed with our old protocol and the second one prospectively followed after the introduction of dextrose gel at 40%. Results: Primary outcome was occurrence of NICU admission and glucose intravenous needs; breastfeeding success was the secondary outcome. Infants in the dextrose oral gel group showed statistically lower need of NICU admission and higher prevalence of exclusive breastfeeding at discharge compared with infants of the historical group. Conclusions: In our population the introduction of dextrose oral gel at 40% to the protocol, helped in the safe management of asymptomatic hypoglycemia in near term infants and, at the same time, implemented breastfeeding.

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Section: Discussionsupporting

confidence: 50%

Management of Asymptomatic Hypoglycemia With Dextrose Oral Gel at 40% in Near Term at-risk Infants to Reduce Intensive Care Need and Promote Breastfeeding

Meneghin¹,

Manzalini²,

Acunzo³

et al. 2021

Preprint

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“…A 2-year follow-up established safety by demonstrating similar rates of processing difficulty and neurosensory impairment between the oral dextrose and placebo groups ( 48 ). A subsequent cost-utility analysis concluded that dextrose gel resulted in a cost-saving of US$782 per baby ( 49 ).…”

Section: Management Of Neonatal Hypoglycemiamentioning

confidence: 99%

Clinical Aspects of Neonatal Hypoglycemia: A Mini Review

Edwards

Harding

2021

Front. Pediatr.

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Introduction: Neonatal hypoglycemia is common and a preventable cause of brain damage. The goal of management is to prevent or minimize brain injury. The purpose of this mini review is to summarize recent advances and current thinking around clinical aspects of transient neonatal hypoglycemia.Results: The groups of babies at highest risk of hypoglycemia are well defined. However, the optimal frequency and duration of screening for hypoglycemia, as well as the threshold at which treatment would prevent brain injury, remains uncertain. Continuous interstitial glucose monitoring in a research setting provides useful information about glycemic control, including the duration, frequency, and severity of hypoglycemia. However, it remains unknown whether continuous monitoring is associated with clinical benefits or harms. Oral dextrose gel is increasingly being recommended as a first-line treatment for neonatal hypoglycemia. There is some evidence that even transient and clinically undetected episodes of neonatal hypoglycemia are associated with adverse sequelae, suggesting that prophylaxis should also be considered. Mild transient hypoglycemia is not associated with neurodevelopmental impairment at preschool ages, but is associated with low visual motor and executive function, and with neurodevelopmental impairment and poor literacy and mathematics achievement in later childhood.Conclusion: Our current management of neonatal hypoglycemia lacks a reliable evidence base. Randomized trials are required to assess the effects of different prophylactic and treatment strategies, but need to be adequately powered to assess outcomes at least to school age.

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“…The overall lifetime cost was considered to be the sum of the initial postnatal hospital costs, and the cumulative annual total post-discharge healthcare expenditure specifically for each outcome over the time horizons of the analysis, discounted at 3.5% [ 44 , 45 ] for costs incurred in timeframes greater than 1 year. Postnatal hospital costs were based on the lengths-of-stay in a general postnatal ward and a neonatal intensive care unit (NICU), and their costs, as described previously [ 6 ], and were converted and inflated to 2018 NZ$ using the methods outlined above. The average cost of a postnatal hospital stay used for an infant with neonatal hypoglycaemia was NZ$7500, and for an infant without neonatal hypoglycaemia was NZ$1100.…”

Section: Methodsmentioning

confidence: 99%

“…Short-term costs have been described previously for infants at increased risk of neonatal hypoglycaemia [ 6 ], but there remains a paucity of high quality prospective evidence examining the post-discharge outcomes of neonatal hypoglycaemia [ 5 , 7 ], and their costs. We have undertaken an economic analysis to compare the costs and utilities for subjects who experienced neonatal hypoglycaemia and those who did not, with the objective of quantifying the total cost burden due to neonatal hypoglycaemia, and, via net monetary benefit loss estimations, an indication of the impact of longer term outcomes useful for future economic evaluations of preventative treatments.…”

Section: Introductionmentioning

confidence: 99%

Cost burden and net monetary benefit loss of neonatal hypoglycaemia

Glasgow

Edlin

Harding

2021

BMC Health Serv Res

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Background Neonatal hypoglycaemia is a common but treatable metabolic disorder that affects newborn infants and which, if not identified and treated adequately, may result in neurological sequelae that persist for the lifetime of the patient. The long-term financial and quality-of-life burden of neonatal hypoglycaemia has not been previously examined. Methods We assessed the postnatal hospital and long-term costs associated with neonatal hypoglycaemia over 80 year and 18 year time horizons, using a health-system perspective and assessing impact on quality of life using quality-adjusted life year (QALYs). A decision analytic model was used to represent key outcomes in the presence and absence of neonatal hypoglycaemia. Results The chance of developing one of the outcomes of neonatal hypoglycaemia in our model (cerebral palsy, learning disabilities, seizures, vision disorders) was 24.03% in subjects who experienced neonatal hypoglycaemia and 3.56% in those who do did not. Over an 80 year time horizon a subject who experienced neonatal hypoglycaemia had a combined hospital and post-discharge cost of NZ$72,000 due to the outcomes modelled, which is NZ$66,000 greater than a subject without neonatal hypoglycaemia. The net monetary benefit lost due to neonatal hypoglycaemia, using a value per QALY of NZ$43,000, is NZ$180,000 over an 80 year time horizon. Conclusions Even under the most conservative of estimates, neonatal hypoglycaemia contributes a significant financial burden to the health system both during childhood and over a lifetime. The combination of direct costs and loss of quality of life due to neonatal hypoglycaemia means that this condition warrants further research to focus on prevention and effective treatment.

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Cost Analysis of Treating Neonatal Hypoglycemia with Dextrose Gel

Abstract: Australian New Zealand Clinical Trials Registry: ACTRN12608000623392.

Cited by 35 publications

References 15 publications

Management of Asymptomatic Hypoglycemia With Dextrose Oral Gel at 40% in Near Term at-risk Infants to Reduce Intensive Care Need and Promote Breastfeeding

Management of Asymptomatic Hypoglycemia With Dextrose Oral Gel at 40% in Near Term at-risk Infants to Reduce Intensive Care Need and Promote Breastfeeding

Clinical Aspects of Neonatal Hypoglycemia: A Mini Review

Cost burden and net monetary benefit loss of neonatal hypoglycaemia

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