Dear all,

 

I would like to know the effect of Oral Dextrose supplementation in the management of initial Asymptomatic Hypoglycemia in term babies. How much it is right to give orally? I feel that it can cause rebound Hypoglycemia...So, is that right to give oral dextrose? NB: Neonatal manual by Cloherty and some of the other articles I read, mentions oral dextrose.

 

Thanks,

Mallikarjuna

Take a look at the topic about sugar gel give orally, a research article published in the Lancet:

 

I think you can find some in the Methods section about how they actually did the study.

Lactose from milk is cleared first pass by the liver after absorption from the intestines and converted to fats. Therefore it does not stimulate insulin secretion  hence it does not cause rebound hypoglycaemia unlike sugar or dextrose solutions. Therefore milk should be the preferred enteral feed esp in IDMs

I agree with dr Sangvi, oral dextrose 5% or more can also cause osmotic diarrhea, if one wants Extra calories one can use HMF with EBM or polycose in proper dilution.

Glucose gel appears to be interesting option Dr Stephen, but it is more of preventive rather a treatment strategy. Are we going to use this in all at risk late preterm and term babies?

Glucose gel appears to be interesting option Dr Stephen, but it is more of preventive rather a treatment strategy. Are we going to use this in all at risk late preterm and term babies?

 

Good point!

But I learnt about one interesting option recently from a French unit where they set a nasogastric tube and use a contineous "feed infusion" to treat hypoglycemia!

Stefan: We do that as well. We have no study on it but since roughly 2 years ago our need for intravenous infusion has dropped.

After discussion with ALB hospital we learned that they are successful in preventing i.v. treatment when giving a supplement of oral Duocal (brand name - carbohydrates/fat) to breast milk.

@Urban Rosenqvist sounds great! We still have project plans...  

Did you find a protocol somewhere that you translated or did you make your own protocol? Would be great to see the protocol if you want to share it.

We also use fortified milk/formula with Duocal - and sometimes have success with that. But I think your strategy is probably the best.

@Stefan Johansson Not yet a protocol on it...

Did I understand you correctly - you mean milk/formula given by nasogastric tube driven by a "food pump" 24h a day? Because that´s what we are doing :-)

Usually when the baby is admitted we try starting with normal bolus feeding but if the baby´s having difficulties in tolerating the given amount we switch to food infusion

Sometimes they don´t tolerate 150ml/kg, sometimes they tolerate 220ml/kg or more. We set it to continous infusion (over 24h) and increase it until glucose levels are under control.   

@Urban Rosenqvist yes, a feeding pump is exactly what I was referring to. Sounds great to hear you have experience with this - maybe we should consider to make a trial (that something we would like to do, randomize to feeding pump vs iv glucose)

There seems to be a little confusion around the use of Dextrose gel - it is used as a treatment for hypoglycemia.I believe there are other studies underway looking at other ways to use it, but this is how our unit has used it for many years now. We give 0.5ml (cc) per kg of bodyweight applied directly to the buccal membranes with a gloved finger.  The baby will then be fed and the BGL checked in 30 minutes. We have not noticed any rebound hypoglycemia. I am not sure what is meant by Asymptomatic hypoglycemia - in our experience checking  the blood glucose is the only way to ascertain whether a baby is hypoglycemic or not.

@JoannieO i think this thread has become a bit confusing, sorry for that.

So you use sugar gel as treatment of diagnosed hypoglycemia? I thought the sugarbaby-trial was a prevention trial incl risk groups at the maternity ward (i.e. Risk groups for hypoglycemia), but I may be wrong by memory. For infants sdmitted to the nicu, Will gel also be usually succesful so you can spare a baby an iv infusion of glucose?

The feeding pump discussion is a separete topic from gel admin, but I think an attractive mode of admin compared to iv infusion of glucose

(and very much OT - our main concern is our glucose measurement apparatus...)

On the OT: The same here... To reduce pain we changed several years ago from heel lancing using a stationary meter to the mobile Freestyle Lite blood glucose meter.

After that we had to deal with, and treat a lot more "hypoglycemias". After changing to another model of Freestyle we now see less hypoglycemias.    

@Urban Rosenqvist do you use the Freestyle Pro?

 

The Sugar babies trial did indeed look at babies at risk of hypoglycemia, however, in our unit we have used dextrose gel as a first line treatment for hypoglycemia for many years. The Sugar babies trial and associated research provided us with the evidence that we needed to underpin this practice.

We use the BD lancet for heelsticks and process the sample immediately - we are lucky enough to have a blood gas analyzer on our unit.  Using dextrose gel as a first treatment, along with feeding, has meant that most babies can be managed without IV fluids.  We prefer to feed breast milk whenever possible, and don't use formula without parental consent.  Sometimes there will be a baby who is on IV fluids until there is enough breast milk if the parents don't want the baby to have formula, but we don't often have babies on IV fluids because of hypoglycemia.

@Stefan Johansson Yes, now the Freestyle Pro.

Can I ask how you all measure blood sugars and whether there is any evidence of blood gas machines versus BM sticks

@spartacus007 we currently use "Freestyle light" (https://freestylediabetes.co.uk/our-products/other-meters/freestyle-lite) and it performs poorly... as it often under-estimates the true value (shows a hypoglycemic value when there is normoglycemia.

We are currently validating Accucheck and Freestyle Pro against our blood gas machine (ABL90) that has accreditation as reference for glucose measurement.  We plan to publish of course, but my impression (without statistical testing) is that both seem to perform reasonably well. 

We are moving to use of I stat machine based testing. Is any one else using them

 

Alok