Oral dextrose gel to treat neonatal hypoglycaemia: Clinician survey

Abstract

Aims To determine the use of oral dextrose gel to treat neonatal hypoglycaemia in New Zealand (NZ), to identify barriers and enablers to the implementation of the guideline and to determine if there is variation in management between clinical disciplines caring for at‐risk babies. Methods An online survey was distributed to clinicians (including doctors, midwives and nurses) caring for babies with neonatal hypoglycaemia via stakeholders and maternity hospitals. Results A total of 251 clinicians from all 20 District Health Boards (DHBs) completed the survey. Of the responding clinicians, 148 (59%) from 15 (75%) DHBs reported oral dextrose gel use in their hospital, and of these, 129 (87%) reported a local guideline. In 12 of 15 (80%) DHBs, oral dextrose gel could be prescribed by midwives. For a clinical scenario of a baby with neonatal hypoglycaemia, doctors were more likely to prescribe oral dextrose gel than midwives (odds ratio (95% confidence interval), 2.9 (2.2–3.8), P < 0.0001). Of 32 possible combinations of treatment options for this scenario, 31 were selected by one or more clinicians. A guideline was perceived to be the most useful enabler, and availability of oral dextrose gel was seen as the most important barrier. Conclusions Oral dextrose gel is widely used to treat neonatal hypoglycaemia in NZ. Increasing availability of dextrose gel and the clinical practice guideline are likely to further increase the use of oral dextrose gel.

Clinical management and knowledge of neonatal hypoglycaemia in Germany: A national survey of midwives and nurses

“…Unlike recent survey results from New Zealand 15 that reported the use of 40% oral dextrose gel by 59% of clinicians, our analysis found that oral dextrose gel is rarely used (10%), despite being mentioned as a treatment option in the AWMF guideline for IDM 10 . However, dextrose gel is still a relatively novel therapeutic option and the first conclusive studies promoting its safety and efficacy have only recently been published 22–24 .…”

“…Therefore, this study aimed to evaluate the knowledge and routine management of NH from the perspective of midwives and nurses and to determine the need for guidelines in the management of NH in Germany. To our knowledge, this is the first analysis on this topic in Germany and the first to focus exclusively on the perspectives of midwives and nurses, as prior studies have mainly evaluated neonatologists' views on NH 11–16 …”

Midwife or doctor local opinion leader to implement a national guideline in babies on postnatal wards (DesIGN): protocol of a cluster-randomised, blinded, controlled trial

“…An implementation tool kit using the barriers and enablers identified from a national survey of stakeholders 13 will be used in the implementation of the guideline. The tool kit will include: copies of the ‘Oral Dextrose gel to treat neonatal hypoglycaemia’ guideline, 6 educational materials including a PowerPoint presentation, health professional and consumer information, flow charts, posters and pocket-cards. Once the local opinion leader (midwife or doctor) has been identified and has agreed to be involved in implementation of the dextrose gel guideline, they will be offered an opportunity to attend an education day and be given the implementation tool kit.…”

“…A New Zealand evidence-based clinical practice guideline has been written as a first step in implementing this new treatment approach, as a change in midwifery and neonatal practice is unlikely to occur rapidly without an active implementation strategy. 6 …”

Effect of prophylactic dextrose gel on the neonatal gut microbiome

“…Neonatal hypoglycaemia is common and may be one of the most readily preventable causes of neurodevelopmental impairment 1. Dextrose gel is widely used as a first-line treatment due to its cost-effectiveness and ease of administration 2 3. Two recent studies 4 5 have also established that prophylactic dextrose gel can reduce the incidence of hypoglycaemia in infants at risk 6…”