The use of intramuscular glucagon to prevent IV glucose infusion in early neonatal hypoglycemia

Kasirer, Yair; Dotan, Ophir; Mimouni, Francis; Wasserteil, Netanel; Hammerman, Cathy; Bin‐Nun, Alona

doi:10.1038/s41372-021-00925-x

Cited by 5 publications

(6 citation statements)

References 35 publications

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“…The studies were conducted in advanced economies, including England, the USA, Canada, Scotland, Japan, Israel, and Hungary. One study was conducted in the 1970s [17], one in the 1980s [18], two in the 1990s [19, 20], one in the 2000s [21], and two in the 2020s [22, 23]. All studies were performed in neonatal intensive care units.…”

Section: Resultsmentioning

confidence: 99%

“…There was moderate risk of bias for this outcome (Table 2). The change in BGC at 1-2 h post-glucagon was reported by 6 studies (N = 323) [17,[19][20][21][22][23]. Meta-analysis showed that glucagon treatment may be associated with a mean (95% CI) increase in BGC or plasma GC of 2.3 (2.1, 2.5) mmol/L (Fig.…”

Section: Important Noncritical Outcomesmentioning

confidence: 88%

“…Godin et al [22] Kasirer et al [23] Overall insulin concentrations are high, and this may explain glucagon unresponsiveness in some infants. Further research is required to understand the influence of other metabolites and hormones on glucagon action.…”

Section: Discussionmentioning

confidence: 99%

“…Critical Outcomes Time to blood glucose normalization after commencing glucagon treatment was reported by 3 studies but data were not in a form suitable for meta-analysis. Carter et al [18] found that 20/25 (80%) of infants achieved normoglycaemia (BGC ≥4 mmol/L) within 3 h; Kasirer et al [23] found that 145/158 (92%) infants achieved normoglycaemia (BGC ≥2.6 mmol/L) within 2 h, and Nakamura et al [20] found that 14/15 (93%) infants achieved normoglycaemia (BGC ≥2.2 mmol/L) within 4 h. There was serious risk of bias for this outcome (Table 2).…”

Section: Neonatal Periodmentioning

confidence: 99%

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Glucagon for Neonatal Hypoglycaemia: Systematic Review and Meta-Analysis

et al. 2022

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Introduction: Glucagon is often used in neonatal hypoglycaemia, but its effects have not been systematically assessed. We undertook a systematic review to determine the efficacy and safety of glucagon treatment for neonatal hypoglycaemia. Methods: We searched MEDLINE, CINAHL, EMBASE, and CENTRAL from inception until May 2021. We included studies that reported one or more prespecified outcomes and compared glucagon with placebo or no glucagon. Studies were excluded if the majority (>70%) of participants were >1 month of age. Two authors independently extracted data. We used ROB-2/modified ROBINS-I to assess risk of bias, GRADE for certainty of evidence, and RevMan for meta-analysis. Results: 100 studies were screened, 37 reviewed in full, and seven single-arm non-randomised intervention studies, involving 348 infants, were included (no trials). Data were insufficient to undertake meta-analysis of the critical outcomes (time to blood glucose normalization, recurrent hypoglycaemia, neurocognitive impairment). In 3 studies, ≥80% of neonates achieved normoglycaemia within 4 h of glucagon administration. However, recurrent hypoglycaemia was common (up to 55%). Glucagon increased blood glucose concentration at 1–2 h by 2.3 mmol/L (95% CI 2.1, 2.5) (low certainty evidence, 6 studies, N = 323). There were few data for other important clinical outcomes. Conclusion: There is a paucity of evidence about the efficacy and safety of glucagon for treatment of neonatal hypoglycaemia. Low certainty evidence suggests that glucagon may increase blood glucose by ∼2.3 mmol/L but recurrent hypoglycaemia appears common. High-quality, randomized controlled trials are required to determine the role of glucagon in managing neonatal hypoglycaemia.

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Section: Resultsmentioning

confidence: 99%

Section: Important Noncritical Outcomesmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Neonatal Periodmentioning

confidence: 99%

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Glucagon for Neonatal Hypoglycaemia: Systematic Review and Meta-Analysis

et al. 2022

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“…For instance, the use of a single intramuscular injection of glucagon has been shown to be effective in reducing NICU admissions for hypoglycemic infants. 15,16 However, this therapy is invasive. A single dose of glucagon does not cover later occurrences of hypoglycemia and raises concerns as it may lead to a rapid increase in blood glucose levels.…”

Section: Discussionmentioning

confidence: 99%

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

Zayek,

Batra,

Ikeri

et al. 2024

Preprint

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Objectives To assess the impact of oral dextrose gel (ODG) treatment on NICU admission rates for hypoglycemic infants in a well-baby nursery. Study Design We retrospectively compared newborn infants, at risk for hypoglycemia, born during the intervention period (n=3775) with historical controls (n=655). Rates of the primary outcome (NICU admission) and secondary outcomes (exclusive breastfeeding, hospital costs) were compared between the groups. Results Following the implementation of ODG supplementation, the NICU admissions rates dropped from 4 % to 2 %, p <0.05, for at-risk infants and from 15 % to 7 %, p <0.05, for hypoglycemic infants in the baseline and intervention periods, respectively. Additionally, the ODG protocol sustained rates of exclusive breastfeeding in contrast to the institutional protocol. Conclusion The adoption of an ODG protocol fosters a more nurturing and baby-friendly environment through reduced NICU transfers, support for exclusive breastfeeding, and decreased hospital costs.

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Oral dextrose gel for hypoglycemia in a well-baby nursery: a baby-friendly initiative

Batra,

Ikeri,

Blake

et al. 2024

J Perinatol

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Objectives To assess the impact of oral dextrose gel (ODG) treatment on NICU admission rates for hypoglycemic infants in a well-baby nursery. Study design We retrospectively compared newborn infants at risk for hypoglycemia born during the intervention period (n = 3775) with historical controls (n = 655). We also compared the rates of the primary outcome (NICU admission) and secondary outcomes (exclusive breastfeeding and hospital costs) between the two periods. Results Following the implementation of ODG supplementation, the NICU admissions rates dropped from 4% to 2%, p < 0.05, for at-risk infants and from 15% to 7%, p < 0.05, for hypoglycemic infants in the baseline and intervention periods, respectively, with an adjusted OR (95% CI) of 0.39 (0.24–0.64), p < 0.001. Additionally, the ODG protocol sustained rates of exclusive breastfeeding in contrast to the institutional protocol. Conclusion The adoption of an ODG protocol fosters a more nurturing and baby-friendly environment through reduced NICU transfers, support for exclusive breastfeeding, and decreased hospital costs.

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The use of intramuscular glucagon to prevent IV glucose infusion in early neonatal hypoglycemia

Cited by 5 publications

References 35 publications

Glucagon for Neonatal Hypoglycaemia: Systematic Review and Meta-Analysis

Glucagon for Neonatal Hypoglycaemia: Systematic Review and Meta-Analysis

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

Oral dextrose gel for hypoglycemia in a well-baby nursery: a baby-friendly initiative

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