OBJECTIVE: Hypoglycemia in neonates can lead to poor neurodevelopmental outcomes. This review aims to evaluate the implementation of an oral dextrose gel protocol for management of neonatal hypoglycemia and its effect on patient outcomes.
SELF ASSESSMENT QUESTION: Which of the following is a potential benefit of using an oral dextrose gel protocol rather than IV dextrose to treat asymptomatic neonatal hypoglycemia as seen in this study?
BACKGROUND: Neonatal hypoglycemia can lead to poor neurodevelopmental outcomes. Risk factors for neonatal hypoglycemia include small for gestational age, large for gestational age, infants of diabetic mothers, and gestational age < 37 weeks at birth. Oral dextrose gel in addition to feeding has demonstrated efficacy and safety for treating hypoglycemia in neonates. Lehigh Valley Reilly Children's Hospital implemented a protocol for management of neonatal hypoglycemia with oral dextrose gel in the newborn nursery in November 2020.
METHODOLOGY: This was a retrospective chart review of infants in the Newborn Nursery (NN) and neonatal intensive care unit (NICU) before and after the implementation of the nursing-driven oral dextrose gel protocol, using blood glucose values of patients with risk factors to screen for hypoglycemia on November 16, 2020. Infants included were born at ≥ 35 weeks gestational age and treated in the NN during the 1 year pre-protocol implementation period (September 30, 2019 – September 29, 2020) and 1 year post-protocol implementation period (January 1, 2021 – December 31, 2021). Exclusion criteria included infants admitted directly to NICU, infants weighing < 2 kg, and infants treated during a 3 month3-month washout period from September 30, 2020 to December 31, 2020. The primary outcome was admission rate of infants from NN to NICU due to hypoglycemia before and after implementation of the protocol. Secondary outcomes included treatment failure (rate of infants requiring > 3 administrations of oral dextrose gel), number of oral dextrose administrations needed to restore normoglycemia, IV dextrose use, and hyperglycemia.
RESULTS: A total of 363 infants given dextrose were includedidentified, with 55 from the pre-protocol period and 308 from the post-protocol period. The rate of NICU admission due to hypoglycemia was 1.4% in the overall study population (n=5937). For the pre-protocol period, 1.1% of patients were admitted to the NICU due to hypoglycemia compared to 1.8% of patients in the post-protocol period (p = 0.0133).. NICU admissions due to hypoglycemia were significantly associated with time period (p = 0.0133). The rate of treatment failure was 3.9% post-protocol. The median number of oral dextrose administrations to restore normoglycemia was 1 (IQR 1-2). IV dextrose was required in 100% of infants pre-protocol and 16.2% post-protocol. Hyperglycemia occurred in 9.1% of infants pre-protocol and 2.3% post-protocol.
CONCLUSIONS: Based on these results, the implementation of an oral dextrose gel protocol did not reduce NICU admissions due to hypoglycemia. However, this review will beis useful to demonstrate to providers benefits of using an oral dextrose gel protocol rather than IV dextrose initially to treat asymptomatic neonatal hypoglycemia. However, this data can be useful for demonstrating to providers the benefits of using oral dextrose gel over IV dextrose. These benefits potentially include lower rates of hyperglycemia, low rate of treatment failure with oral dextrose gel, and decreased need for IV dextrose when using an oral dextrose gel protocol.
PGY1 Pharmacy Resident, Lehigh Valley Health Network
My name is Stephen Ensor, PharmD and I am a PGY1 pharmacy resident at Lehigh Valley Health Network in Allentown, PA. I received my PharmD degree from University of Kentucky in 2023. For my future plans after PGY1, I accepted a PGY2 oncology pharmacy residency position at Norton Children's... Read More →
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