Mid-Childhood Outcomes after Dextrose Gel Treatment of Neonatal Hypoglycaemia: Follow-Up of the Sugar Babies Randomized Trial

Abstract

<b><i>Introduction:</i></b> Dextrose gel is widely used as first-line treatment for neonatal hypoglycaemia given its cost-effectiveness and ease of use. The Sugar Babies randomized trial first showed that 40% dextrose gel was more effective in reversing hypoglycaemia than feeding alone. Follow-up of the Sugar Babies Trial cohort at 2 and 4.5 years of age reported that dextrose gel appeared safe, with similar rates of neurosensory impairment in babies randomized to dextrose or placebo gel. However, some effects of neonatal hypoglycaemia may not become apparent until school age. <b><i>Methods:</i></b> Follow-up of the Sugar Babies Trial cohort at 9–10 years of age was reported. The primary outcome was low educational achievement in reading or mathematics. Secondary outcomes included other aspects of educational achievement, executive function, visual-motor function, and psychosocial adaptation. <b><i>Results:</i></b> Of 227 eligible children, 184 (81%) were assessed at a mean (SD) age of 9.3 (0.2) years. Low educational achievement was similar in dextrose and placebo groups (36/86 [42%] vs. 42/94 [45%]; RR 1.04, 95% CI 0.76, 1.44; <i>p</i> = 0.79). Children allocated to dextrose gel had lower visual perception standard scores (95.2 vs. 100.6; MD −5.68, 95% CI −9.79, −1.57; <i>p</i> = 0.006) and a greater proportion had low (<85) visual perception scores (20/88 [23%] vs. 10/95 [11%]; RR 2.23, 95% CI 1.13, 4.37; <i>p</i> = 0.02). Other secondary outcomes, including other aspects of visual-motor function, were similar in both groups. <b><i>Conclusion:</i></b> Treatment dextrose gel does not appear to result in any clinically significant differences in educational achievement or other neurodevelopmental outcomes at mid-childhood.

Oral Dextrose Gel for Hypoglycemia in a well baby nursery: a baby friendly initiative

“…20 In addition, the approach of serial monitoring of the infant in the newborn nursery with intervention such as OGD therapy or NICU transfer only when indicated has been proven to be safe. 2,4,5 Other advantages, such as reduction in hospital expenses, have also been described. This reduction in healthcare costs allows for the reallocation of funds to other critical areas within the healthcare ecosystem.…”

“…Furthermore, the use of ODG was considered safe, with no adverse neurosensory outcomes observed in infants at 2 years, 4.5 years and 9 years of age. 2,4,5 Surprisingly, more recent studies investigating the potential advantages of ODG therapy have questioned its main bene ts. The primary goal of ODG therapy is to prevent the separation of newborns from their mothers by avoiding NICU admissions for intravenous therapies.…”

Prophylactic Dextrose Gel Use in Newborns at Risk for Hypoglycemia

“…However, more recent studies showed no signi cant association of neonatal hypoglycemia with educational achievements in mid-childhood. (42,43) The long-term effects of using prophylactic dextrose gel were studied by prospectively following the participants of the hPOD study group. It was noted that the use of gel, compared with placebo, resulted in no signi cant difference in the risk of neurosensory impairment at 2 years corrected age.…”

Proposed Screening for Congenital Hyperinsulinism in Newborns: Perspective from a Neonatal–Perinatal Medicine Group

“…Transitional neonatal hypoglycemia has characteristic features of hyperinsulinism, including the suppression of ketone production, the inhibition of glycogenolysis, and an exaggerated response to glucagon; it usually resolves within 36-48 h after birth [7]. Transi-tional neonatal hypoglycemia is not associated with adverse neurodevelopment [4], and treatment has not been shown to confer neurocognitive benefits [14,15]. Alternatively, the relatively underrecognized perinatal stress-induced hyperinsulinism is a prolonged form of non-genetic hyperinsulinemic hypoglycemia associated with perinatal stress (e.g., perinatal depression, small for gestational age, prematurity, and preeclampsia), characterized by the requirement for a high glucose infusion rate, high responsivity to diazoxide (a drug that suppresses insulin secretion via the activation of membrane K ATP channels), and eventual resolution within weeks to months after birth, confirmed by a safety fast [16,17].…”