Cost-Utility Analysis of Prophylactic Dextrose Gel vs Standard Care for Neonatal Hypoglycemia in At-Risk Infants

Glasgow, Matthew J.; Edlin, Richard; Harding, Jane E

doi:10.1016/j.jpeds.2020.06.073

Cited by 28 publications

(10 citation statements)

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“…A cost analysis was performed by Glasgow et al showing one NICU admission for hypoglycemia is estimated to cost $10,709 per encounter. 22 These results show that food insecurity could have an impact on neonatal outcomes. These findings warrant further confirmation.…”

Section: Discussionmentioning

confidence: 83%

The Relationship between Food Security and Gestational Diabetes among Pregnant Women

Cooper

Graham

Kuo

et al. 2022

AJP Rep

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The objective were to: (1) evaluate associations between food security and women diagnosed with gestational diabetes mellitus (GDM) and (2) evaluate if women in food insecure (FI) households had adverse maternal and neonatal outcomes. This was an observational study from October 2018 until September 2019. Postpartum resident clinic patients who delivered term, singleton infant at 37 weeks' or longer gestation were screened. Participants completed a survey using the U.S. Household Food Security Survey Module (US HFSSM). Survey responses were classified as: food secure (FS) and FI (marginal, low, very low FS). The primary outcome was GDM. Our secondary outcome was neonatal intensive care unit (NICU) admissions for hypoglycemia. We evaluated the rate of GDM in FS and FI groups. Demographic data included: prepregnancy body mass index, total weight gain during pregnancy, birth weight, and mode of delivery. A logistic regression model was used to analyze the association between food insecurity and GDM. A p-value of less than 0.05 was considered statistically significant. There were 150 patients screened to participate; of these, 70 patients were enrolled (36 GDM and 34 without GDM [NGDM]). More patients in FI households, 71% (n = 17), were diagnosed with GDM, compared with 33% (n = 15) in the FS (FS) households (adjusted odds ratio 7.05; p < 0.01). Of patients who reported FI, 50% (n = 12) were black, 46% (n = 11) Hispanic, and 4% (n = 1) Caucasian, compared with 13% (n = 6) black, 30% (n = 14) Hispanic, and 57% (n = 26) Caucasian in patients who reported FS (p < 0.001). Although not significant, 25% (n = 6) of neonates from an FI household had an NICU admission for hypoglycemia compared with 7% (n = 3) from an FS household (p = 0.054). Pregnant women with GDM are more likely to experience FI than those with NGDM. Infants of mothers in FI households also had increased rates of NICU admission for hypoglycemia.

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Section: Discussionmentioning

confidence: 83%

The Relationship between Food Security and Gestational Diabetes among Pregnant Women

Cooper

Graham

Kuo

et al. 2022

AJP Rep

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“…However, it does reduce the incidence of hypoglycemia, with a number needed to treat of 21 (95% confidence interval 11 to 141). Since prophylaxis also appears to be safe and is likely to be cost-effective [ 13 ], clinicians and clinical guideline groups should consider whether introduction into clinical practice is warranted at this time. The key reason for screening and treatment of neonatal hypoglycemia is to prevent brain injury, and our preliminary data suggest that use of dextrose gel to prevent hypoglycemia may improve some aspects of development at 2 years of age [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

Section: Plos Medicinementioning

confidence: 99%

Evaluation of oral dextrose gel for prevention of neonatal hypoglycemia (hPOD): A multicenter, double-blind randomized controlled trial

et al. 2021

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Background Neonatal hypoglycemia is common and can cause brain injury. Buccal dextrose gel is effective for treatment of neonatal hypoglycemia, and when used for prevention may reduce the incidence of hypoglycemia in babies at risk, but its clinical utility remains uncertain. Methods and findings We conducted a multicenter, double-blinded, placebo-controlled randomized trial in 18 New Zealand and Australian maternity hospitals from January 2015 to May 2019. Babies at risk of neonatal hypoglycemia (maternal diabetes, late preterm, or high or low birthweight) without indications for neonatal intensive care unit (NICU) admission were randomized to 0.5 ml/kg buccal 40% dextrose or placebo gel at 1 hour of age. Primary outcome was NICU admission, with power to detect a 4% absolute reduction. Secondary outcomes included hypoglycemia, NICU admission for hypoglycemia, hyperglycemia, breastfeeding at discharge, formula feeding at 6 weeks, and maternal satisfaction. Families and clinical and study staff were unaware of treatment allocation. A total of 2,149 babies were randomized (48.7% girls). NICU admission occurred for 111/1,070 (10.4%) randomized to dextrose gel and 100/1,063 (9.4%) randomized to placebo (adjusted relative risk [aRR] 1.10; 95% CI 0.86, 1.42; p = 0.44). Babies randomized to dextrose gel were less likely to become hypoglycemic (blood glucose < 2.6 mmol/l) (399/1,070, 37%, versus 448/1,063, 42%; aRR 0.88; 95% CI 0.80, 0.98; p = 0.02) although NICU admission for hypoglycemia was similar between groups (65/1,070, 6.1%, versus 48/1,063, 4.5%; aRR 1.35; 95% CI 0.94, 1.94; p = 0.10). There were no differences between groups in breastfeeding at discharge from hospital (aRR 1.00; 95% CI 0.99, 1.02; p = 0.67), receipt of formula before discharge (aRR 0.99; 95% CI 0.92, 1.08; p = 0.90), and formula feeding at 6 weeks (aRR 1.01; 95% CI 0.93, 1.10; p = 0.81), and there was no hyperglycemia. Most mothers (95%) would recommend the study to friends. No adverse effects, including 2 deaths in each group, were attributable to dextrose gel. Limitations of this study included that most participants (81%) were infants of mothers with diabetes, which may limit generalizability, and a less reliable analyzer was used in 16.5% of glucose measurements. Conclusions In this placebo-controlled randomized trial, prophylactic dextrose gel 200 mg/kg did not reduce NICU admission in babies at risk of hypoglycemia but did reduce hypoglycemia. Long-term follow-up is needed to determine the clinical utility of this strategy. Trial registration ACTRN 12614001263684.

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“…Alguns estudos sobre o gel de glicose (COORS et al, 2018;TER et al, 2017; STANZO; DESAI; CHIRUVOLU, 2020), fizeram o uso de produtos industrializados prontos saborizados e com diversos aditivos, o que não é ideal para o consumo de recém-nascidos (SOLIMANO et al, 2019 Glasgow et al (2018Glasgow et al ( , 2020 analisou o custo da utilização do gel de glicose como prevenção e como tratamento da hipoglicemia e concluiu que o produto é vantajoso quando comparado ao tratamento convencional, pois diminui os gastos do sistema de saúde relacionados à hipoglicemia. Burakevych et al (2019) mostrou que o tratamento da hipoglicemia neonatal com gel de glicose ou fórmula isoladamente levou ao aumento das concentrações de glicose, enquanto apenas a amamentação não.…”

Section: Discussionunclassified

Pacientes Com Diabetes Mellitus Tipo 2 Com Risco De Amputação De Membros Inferiores

Barbosa¹

2021

Medicina: Aspectos Epidemiológicos, Clínicos E Estratégicos De Tratamento 2

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Direitos para esta edição cedidos à Atena Editora pelos autores. Todo o conteúdo deste livro está licenciado sob uma Licença de Atribuição Creative Commons. Atribuição-Não-Comercial-NãoDerivativos 4.0 Internacional (CC BY-NC-ND 4.0).O conteúdo dos artigos e seus dados em sua forma, correção e confiabilidade são de responsabilidade exclusiva dos autores, inclusive não representam necessariamente a posição oficial da Atena Editora. Permitido o download da obra e o compartilhamento desde que sejam atribuídos créditos aos autores, mas sem a possibilidade de alterá-la de nenhuma forma ou utilizá-la para fins comerciais. Todos os manuscritos foram previamente submetidos à avaliação cega pelos pares, membros do Conselho Editorial desta Editora, tendo sido aprovados para a publicação com base em critérios de neutralidade e imparcialidade acadêmica.A Atena Editora é comprometida em garantir a integridade editorial em todas as etapas do processo de publicação, evitando plágio, dados ou resultados fraudulentos e impedindo que interesses financeiros comprometam os padrões éticos da publicação. Situações suspeitas de má conduta científica serão investigadas sob o mais alto padrão de rigor acadêmico e ético.

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Cost-Utility Analysis of Prophylactic Dextrose Gel vs Standard Care for Neonatal Hypoglycemia in At-Risk Infants

Cited by 28 publications

References 50 publications

The Relationship between Food Security and Gestational Diabetes among Pregnant Women

The Relationship between Food Security and Gestational Diabetes among Pregnant Women

Evaluation of oral dextrose gel for prevention of neonatal hypoglycemia (hPOD): A multicenter, double-blind randomized controlled trial

Pacientes Com Diabetes Mellitus Tipo 2 Com Risco De Amputação De Membros Inferiores

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