Dextrose gel to prevent transitional neonatal hypoglycaemia may do more harm than good

Administering a single dose of dextrose gel as prophylaxis against transitional neonatal hypoglycaemia does not help with the risk of neurocognitive impairment at early school age and even appears to have adverse effects on psychological well-being, according to a study.

The study included children who participated in the Hypoglycaemia Prevention With Oral Dextrose (hPOD) multicentre, placebo-controlled trial and underwent follow-up at 6 to 7 years’ corrected age. These children were born at ≥35 weeks of gestation, weighed ≥2.2 kg, and had at least one risk factor for transitional neonatal hypoglycaemia: preterm, maternal diabetes, small or large for gestational age, or birth weight of <2.5 kg or >4.5 kg.

In the trial, the children were randomly assigned to receive a 0.2-g/kg dose of buccal or placebo (hydroxymethylcellulose, 2%) at 1 h of age. The primary outcome for the school-age follow-up was neurocognitive impairment at 6–7 years of age (ie, standard score more than 1 standard deviation [SD] below the normative mean on at least one of the seven items from the National Institutes of Health Toolbox). Exploratory outcomes included components of the primary outcome, low numeracy, visual perception, emotional-behavioural difficulty, low physical or psychosocial functioning, and overweight/obesity.

A total of 532 of 652 children in the dextrose gel group and 535 of 642 in the placebo group underwent follow-up. The proportion of those with neurocognitive impairment did not significantly differ between the two groups (59 percent vs 57 percent, respectively; adjusted risk difference [aRD], 3 percent; p=0.36).

Furthermore, a greater percentage of children who received dextrose gel vs placebo had emotional-behavioural difficulty (24 percent vs 18 percent; aRD, 7 percent) and low psychosocial function (17 percent vs 12 percent; aRD, 6 percent).

The findings do not support the routine use of dextrose gel for the prevention of transitional neonatal hypoglycaemia.