Effect of prophylactic dextrose gel on the neonatal gut microbiome

Abstract

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 whose parents consented to participation in the hypoglycaemia Prevention in newborns with Oral Dextrose trial (hPOD). Infants were randomised to receive prophylactic dextrose gel or placebo gel, or were not randomised and received no gel (controls). Stool samples were collected on days 1, 7 and 28.Main outcome measuresThe primary outcome was microbiome beta-diversity at 4 weeks. Secondary outcomes were beta-diversity, alpha-diversity, bacterial DNA concentration, microbial community stability and relative abundance of individual bacterial taxa at each time point.ResultsWe analysed 434 stool samples from 165 infants using 16S rRNA gene amplicon sequencing. There were no differences between groups in beta-diversity at 4 weeks (p=0.49). There were also no differences between groups in any other microbiome measures including beta-diversity (p=0.53 at day 7), alpha-diversity (p=0.46 for day 7 and week 4), bacterial DNA concentration (p=0.91), microbial community stability (p=0.52) and microbial relative abundance at genus level. There was no evidence that exposure to any dextrose gel (prophylaxis or treatment) had any effect on the microbiome. Mode of birth, type of milk fed, hospital of birth and ethnicity were all associated with differences in the neonatal microbiome.ConclusionsClinicians and consumers can be reassured that dextrose gel used for prophylaxis or treatment of neonatal hypoglycaemia does not alter the neonatal gut microbiome.Trial registration number12614001263684.

Prophylactic Dextrose Gel Use in Newborns at Risk for Hypoglycemia

“…Its use has also been shown not to alter the neonatal gut microbiome. (11) Despite this, there is limited evidence on the use of dextrose gel as a preventive measure to reduce the incidence of hypoglycemia and subsequent admission to the NICU. A dose-nding study by Hegarty et al (The Pre-hPOD study) in 2016 concluded that 40% dextrose gel at a dose of 200 mg/kg (0.5 ml/kg) administered before the initial feed effectively reduced the incidence of hypoglycemia in the at-risk population.…”

What are the barriers preventing the screening and management of neonatal hypoglycaemia in low-resource settings, and how can they be overcome?

“…Neonatal hypoglycaemia is the most common metabolic condition in newborns [ 2 ], causing significant long-term disability, seizures and death which is largely preventable [ 3 – 7 ]. Since this statement from the WHO, there has been considerable research in high and upper-middle income countries (HUMIC) advancing knowledge surrounding the prevention, treatment and management of neonatal hypoglycaemia [ 8 – 12 ]. This has changed clinical practice for millions of babies and families in such countries.…”