Dextrose gel for neonatal hypoglycaemia (the Sugar Babies Study): a randomised, double-blind, placebo-controlled trial.
BACKGROUND
Neonatal hypoglycaemia is common, and a preventable cause of brain damage. Dextrose gel is used to reverse hypoglycaemia in individuals with diabetes; however, little evidence exists for its use in babies. We aimed to assess whether treatment with dextrose gel was more effective than feeding alone for reversal of neonatal hypoglycaemia in at-risk babies.


METHODS
We undertook a randomised, double-blind, placebo-controlled trial at a tertiary centre in New Zealand between Dec 1, 2008, and Nov 31, 2010. Babies aged 35-42 weeks' gestation, younger than 48-h-old, and at risk of hypoglycaemia were randomly assigned (1:1), via computer-generated blocked randomisation, to 40% dextrose gel 200 mg/kg or placebo gel. Randomisation was stratified by maternal diabetes and birthweight. Group allocation was concealed from clinicians, families, and all study investigators. The primary outcome was treatment failure, defined as a blood glucose concentration of less than 2·6 mmol/L after two treatment attempts. Analysis was by intention to treat. The trial is registered with Australian New Zealand Clinical Trials Registry, number ACTRN12608000623392.


RESULTS
Of 514 enrolled babies, 242 (47%) became hypoglycaemic and were randomised. Five babies were randomised in error, leaving 237 for analysis: 118 (50%) in the dextrose group and 119 (50%) in the placebo group. Dextrose gel reduced the frequency of treatment failure compared with placebo (16 [14%] vs 29 [24%]; relative risk 0·57, 95% CI 0·33-0·98; p=0·04). We noted no serious adverse events. Three (3%) babies in the placebo group each had one blood glucose concentration of 0·9 mmol/L. No other adverse events took place.


CONCLUSIONS
Treatment with dextrose gel is inexpensive and simple to administer. Dextrose gel should be considered for first-line treatment to manage hypoglycaemia in late preterm and term babies in the first 48 h after birth.


BACKGROUND
Waikato Medical Research Foundation, the Auckland Medical Research Foundation, the Maurice and Phyllis Paykel Trust, the Health Research Council of New Zealand, and the Rebecca Roberts Scholarship.
Newborn Intensive Care Unit, Waikato District Health Board, Hamilton, New Zealand; Liggins Institute, University of Auckland, Auckland, New Zealand.
Deborah L
DL
Harris
Newborn Intensive Care Unit, Waikato District Health Board, Hamilton, New Zealand.
Philip J
PJ
Weston
Mechanical Engineering Department, University of Canterbury, Christchurch, New Zealand.
Matthew
M
Signal
Mechanical Engineering Department, University of Canterbury, Christchurch, New Zealand.
J Geoffrey
JG
Chase
Liggins Institute, University of Auckland, Auckland, New Zealand. Electronic address: j.harding@auckland.ac.nz.
Jane E
JE
Harding
D001786:Blood Glucose / Q000187:drug effects; D001903:Bottle Feeding; D001942:Breast Feeding; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D005782:Gels; D005947:Glucose / Q000008:administration & dosage*; D006801:Humans; D007003:Hypoglycemia / Q000188:drug therapy*; D007231:Infant, Newborn; D008297:Male; D013549:Sweetening Agents / Q000008:administration & dosage*; D017211:Treatment Failure
D001786:Blood Glucose; D005782:Gels; D013549:Sweetening Agents; D005947:Glucose