Treatment of neonatal hypoglycemia with minibolus and intravenous glucose infusion

Lilien, Lawrence D.; Pildes, Rosita S.; Srinivasan, Gopal; Voora, Sambasivarao; Yeh, T. F.

doi:10.1016/s0022-3476(80)80499-9

Cited by 87 publications

(36 citation statements)

References 5 publications

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“…If the blood glucose concentration remains low, admission to the Newborn Intensive Care Unit (NICU) for intravenous glucose is usually indicated. 15 NICU admission usually means that mother and baby are separated, which may delay the establishment of breast feeding.…”

Section: Resultsmentioning

confidence: 99%

“…Lilen and colleagues reported that a mini-bolus of 200 mg/kg intravenous dextrose improved blood glucose concentrations without hyperglycemia. 15 We chose the same dose for buccal glucose administration, and also found that rebound hypoglycemia was uncommon and occurred with similar frequency in both groups. However, consistent with the overall findings that dextrose gel reduced treatment failure, recurrent hypoglycemia was less common in babies who received dextrose gel when measured by continuous interstitial glucose monitoring, despite these babies receiving less frequent feeds.…”

Section: Discussionmentioning

confidence: 99%

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Dextrose gel for neonatal hypoglycaemia (the Sugar Babies Study): a randomised, double-blind, placebo-controlled trial

et al. 2013

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BackgroundNeonatal hypoglycemia is common and a preventable cause of brain damage.Dextrose gel is used to reverse hypoglycemia in diabetics. However, there is little evidence for its use in babies. MethodWe enrolled 514 babies 35 to 42 weeks' gestation, < 48 hours, and at risk of hypoglycemia, to a randomized, double-blind placebo controlled trial to determine whether 40% dextrose gel massaged into the buccal mucosa is more effective than feeding alone in reversing hypoglycemia. Hypoglycemic babies were randomized to 40% dextrose gel 200 mg/kg (n= 118) or placebo (n= 119) and encouraged to feed.Primary outcome was treatment failure (blood glucose concentration <2·6 mmol/L) after two treatment attempts. FindingsDextrose gel reduced the frequency of treatment failure (16/118 (14%) in dextrose vs. 29/119 (24%) in placebo group, RR 0·57; 95% CI 0·33 to 0·98; p=0·04). Babies receiving dextrose gel were less likely to be admitted to intensive care for hypoglycemia, (16/118 (14%) vs. 30/119 (25%); RR 0.54 (0.31, 0.93); P=0.03), to receive formula feeds (median 7 vs. 10 feeds; median difference 2; 95% CI 0 to 4; p=0·04) and to be formula fed at two weeks (5/118 (4%) vs.15/119 (13%), RR 0·34; 95% CI 0·13 to 0·90; p=0·03). 3 InterpretationDextrose gel should be considered for first-line treatment for management of hypoglycemia in late preterm and term babies in the first 48 hours after birth.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Dextrose gel for neonatal hypoglycaemia (the Sugar Babies Study): a randomised, double-blind, placebo-controlled trial

et al. 2013

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“…The excess glucose stimulates the pancreatic β cells to secrete insulin and with each succeeding bolus, it decreases the threshold for insulin release but also inhibit glucagon release, thus resulting into hyperinsulinism which causes rebound hypoglycemia (10) . It has been recommended by Lilien et al that when dextrose boluses are given to treat hypoglycemia, they should be immediately followed by a continuous dextrose infusion to prevent hyperglycemia with resultant rebound hypoglycemia (11) . The overall survival was high (97%) in this study and it was similar for both study groups.…”

Section: Discussionmentioning

confidence: 99%

Dextrose boluses versus burette dextrose infusions in prevention of hypoglycemia among preterms admitted at Mulago Hospital: an open label randomized clinical trial.

Kutamba¹,

Lubega²,

Mugalu³

et al. 2014

Afr H. Sci.

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Background: Hypoglycemia is a major cause of morbidity and mortality among preterm infants and its management remains a challenge in resource limited settings. Use of dextrose infusion by the recommended infusion pumps is not feasible in our environment due to their high costs and yet the current use of mini dextrose boluses with syringes as adapted at Mulago national referral and tertiary teaching hospital has unknown efficacy in prevention of hypoglycemia Objective: We determined the efficacy of dextrose infusions by burettes versus two hourly dextrose boluses in prevention of hypoglycemia among preterms admitted in the first 72 hours at Special Care Unit, Mulago Hospital. Methods: One hundred and forty preterms aged 0 to 24 hours of life were randomized to receive 10% IV dextrose either as mini boluses or by infusion using burettes in an open label clinical trial. Blood glucose was measured at 0, two hourly for next 6 hours, 6 hourly for next 12 hours and thereafter 12 hourly until end of 72 hours following admission. Primary end point was incidence of hypoglycemia (random blood sugar (RBS) < 2.6mmol/l) which was expressed as relative risk (RR). Efficacy of the dextrose infusion was computed using 1-RR. Results: From February 2012 to April 2012, 68 preterms in the bolus arm and 72 in the infusion arm were studied. Hypoglycemia was detected in 34% (48/140). The incidence of hypoglycemia in the bolus arm was 59% (40/68) compared to 11% (8/72) in the infusion arm (RR; 0.19, 95% CI; 0.09-0.37). Efficacy (1-RR) of infusion by burettes versus boluses in prevention of hypoglycemia among preterms was 0.81 (95% CI; 0.63-0.90). Conclusion: Continuous 10% dextrose infusion by burettes reduced the incidence of hypoglycemia by 81% in the first 72 hours of admission compared to two hourly 10% mini dextrose boluses among preterms admitted at Special Care Unit, Mulago Hospital.(ClinicalTrials.gov Identifier: NCT01688674)

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“…A minibolus should always be followed by intravenous glucose infusion. The glucose infusion should be started at an infusion rate of 6-8 mg/kg per min (Lilien et al, 1980). The glucose infusion rate (GIR) should then be titrated with repeated blood glucose estimations.…”

Section: Treatment Of Neonatal Hypoglycemiamentioning

confidence: 99%

An Update on Neonatal Hypoglycemia

Kumar¹,

Saini²

2011

Hypoglycemia - Causes and Occurrences

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Treatment of neonatal hypoglycemia with minibolus and intravenous glucose infusion

Cited by 87 publications

References 5 publications

Dextrose gel for neonatal hypoglycaemia (the Sugar Babies Study): a randomised, double-blind, placebo-controlled trial

Dextrose gel for neonatal hypoglycaemia (the Sugar Babies Study): a randomised, double-blind, placebo-controlled trial

Dextrose boluses versus burette dextrose infusions in prevention of hypoglycemia among preterms admitted at Mulago Hospital: an open label randomized clinical trial.

An Update on Neonatal Hypoglycemia

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