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Pediatric Healthcare & Pediatric Infections 2017
September 20-22, 2017 | Toronto, Canada
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10TH AMERICAN PEDIATRICS HEALTHCARE &
PEDIATRIC INFECTIOUS DISEASES CONGRESS
Introduction: Transient neonatal hypoglycemia is a common
problem affecting many newborns. Up to 15% of healthy
newborns andup to50%of babies inat risk groups areaffected.
Independent risk factors for hypoglycemia includeprematurity,
high or low for gestational age birth weight as well as infants
born to mothers with diabetes. Correcting critically low blood
glucose concentration is important to avoid more serious
complications and adverse outcomes. Critical hypoglycemia
can put newborns at risk for potentially life threatening
consequences including seizures, brain damage, coma and
death. Traditional approach in management of neonatal
hypoglycemia included intense feeding interventions as well
as close blood glucose monitoring. Intravenous dextrose was
reserved to babies in whom the initial conservative approach
failed. Despite varying protocols, many babies still struggle
with low blood glucose and require more frequent monitoring
which causes more lab draws, disruption of bonding between
a mother and a baby, interruption of breastfeeding, and may
need to transfer to a neonatal intensive care unit (NICU).
More recently, oral dextrose gel use has been shown to be
beneficial as an adjunct therapy in management of neonatal
hypoglycemia. This study explores the effect of oral dextrose
gel on correcting critically lowblood glucose levels in neonates.
Methods: Dextrose gel has been incorporated into a well-
established hypoglycemia protocol which was based on the
American Academy of Pediatrics guidelines. 40% dextrose gel
was administered in addition to standard interventions with
intense feeding when indicated. The trial has been initiated in
March of 2016. Subjects included were all newborns that met
criteria of small for gestational age (SGA), large for gestational
age (LGA), infants of diabetic mothers (IDM), and preterm
(<37 weeks) who are born within that time frame. Patients
were divided into two groups based upon their admission
date. Those admitted prior to oral dextrose gel trial and those
admitted up to six months following oral dextrose trial. Data
was collected from a retrospective chart review include blood
glucose concentration, comorbid conditions, number of oral
dextrose gel doses administered, need for transfer to NICU for
treatment with an intravenous glucose and length of stay in
NICU.
Results: Primary outcome variables for this study are the need
to transfer to NICU due to critical hypoglycemia and a length
of stay in NICU. Critically low blood glucose concentration in
the first 4 hours of age is defined as less than 25 mg/dl. There
was a 12% reduction in need for NICU transfers for intravenous
glucose treatment due to critical hypoglycemia in infants
treated with oral dextrose gel vs. infants who received intense
feeding intervention only (38% vs 50%). Moreover, there was
a 27% reduction in length of hospital stay in infants who was
transferred to NICU due to hypoglycemia after an initial trial
of dextrose gel. The beneficial effect of oral dextrose gel in
correcting critical hypoglycemia was observed across all four
risk factors for hypoglycemia.
Conclusion: 40% oral dextrose gel is an effective treatment
in correcting critically low blood glucose concentration in
newborn babies with risk factors. It is simple, inexpensive and
safe intervention. It has been shown to be superior to intense
feeding intervention alone in treating critical hypoglycemia,
and an effective tool in decreasing the need for treatment with
an intravenous glucose. Oral dextrose use shortens duration
of hospital stay due to hypoglycemia.
Speaker Biography
Lana Gagin attended Bashkirian State University Medical School. She completed her
Pediatric Residency at the Michigan State University’s College of Human Medicine
GRMEP in 2007. She earned her Master’s degree in Public Health at the University
of Michigan in 2010 while also working as a pediatrician in the Outpatient General
Pediatric Clinic. She joined the staff of the Helen DeVos Children’s Hospital’s Academic
General Pediatrics in 2010. In 2011, she joined the staff of Spectrum Health Medical
Group and became a Medical Director of Newborn Services in Grand Rapids Campus.
As a Medical Director she led the team of physicians in establishing new practices
for breastfeeding support which resulted in a successful Baby-Friendly Hospital
designation in 2014. She serves as a core faculty at the Pediatric Residency Program
at Spectrum Health. She is a co-founder and a Director of Quality Improvement and
Patient Safety Rotation, and has been leading multiple quality improvement initiatives.
She completed her Lean Healthcare Certification at the University of Michigan in 2014.
In 2015, she became an International Board Certified Lactation Consultant.
e:
Lana Gagin
Helen DeVos Childrens Hospital, USA
Dextrose gel use in treatment of critical hypoglycemia in neonates