166 - Evaluation of Dextrose Gel Use in Neonatal Hypoglycemia- A Single Center Study

Poster Number: 166
Publication Number: 166.233

Stephanie M. Abuso, The Children’s Medical Center at NYU Winthrop Hospital, Glendale, NY, United States; Jenni J. Choi, NYU Langone Hospital- Long Island, Mineola, NY, United States; Meredith Akerman, The Children’s Medical Center at NYU Winthrop Hospital, Mineola, NY, United States; Rania El-Khawam, The Children’s Medical Center at NYU Winthrop Hospital, Mineola, NY, United States; Ranjith Kamity, New York University Long Island School of Medicine, Mineola, NY, United States; Christie Clauss, The Children’s Medical Center at NYU Winthrop Hospital, Mineola, NY, United States; Morcos Hanna, Texas Children's Hospital, Houston, TX, United States; Nazeeh Hanna, NYU Langone-Long Island, Mineola, NY, United States; Vikramaditya Dumpa, New York University Long Island School of Medicine, Bronx, NY, United States

Background: The incidence of neonatal hypoglycemia (NH) is higher in infants with certain risk factors such as prematurity, small for gestational age, large for gestational age, maternal diabetes, and perinatal asphyxia. The use of oral dextrose gel in NH has been proven to reduce the need for intravenous dextrose and NICU admissions. However, it is not clear if dextrose gel treatment is associated with a successful response among the various at-risk groups. . Also, there are no clear guidelines on the use of dextrose gel in symptomatic NH.

Objective: The primary objective is to identify the risk factors associated with unsuccessful response to dextrose gel treatment, i.e. admission to NICU in NH. The secondary objective is to evaluate the effectiveness of dextrose gel in mild to moderate NH with symptoms.

Design/Methods: We analyzed a retrospective cohort of 969 healthy newborns in well baby nursery diagnosed with NH in first 24 hours of life, from 10/1 to 9/21. Individual chart review was performed for data extraction. Infants were excluded if they had no known risk factor for NH, had severe hypoglycemia ( < 25 mg/dl) or if they were admitted to NICU for any reason other than NH. Jitteriness or mild hypothermia are the signs noted in symptomatic NH in this study. Chi-square test or Fisher's exact test, as deemed appropriate, for categorical variables and the two sample t-test or Mann-whitney test for continuous data are used to compare those who had a successful or unsuccessful response to dextrose gel.

Results: Of the 969 included infants with NH, 143 (14.8%) failed dextrose gel treatment and were admitted to NICU. Male gender and cesarean section are associated with a higher risk of dextrose gel failure (Table 1). Maternal gestational diabetes was the highest predictor of  of dextrose gel failure (p=0.04). Use of dextrose gel in symptomatic NH resulted in avoidance of NICU admission in majority of infants (77.5% vs. 22.5%) but these infants are still at higher risk of dextrose gel failure (Table 2).Conclusion(s): Infants of gestational diabetic mothers (IDM) and symptomatic NH infants are at higher risk of dextrose gel treatment failure needing admission to NICU. If larger studies prove this association, strategies aimed at increasing glucose homeostasis such as early skin-to-skin, early supplementation and frequent breast-feeding can be promoted in IDM receiving dextrose gel. Further studies are needed to evaluate role of dextrose gel in mild to moderate symptomatic NH that will enable avoiding NICU admission and promoting mother-baby bonding.
Table 1: Demographics of infants with neonatal hypoglycemiaSGA- Small for gestational age; LGA- Large for gestational age; IDM- Infants of gestational diabetes mellitus mothers; * Male gender- Successful vs. Unsuccessful response (69.2% vs. 30.7%, p=0.01); ** Cesarean section- Successful vs. Unsuccessful response (58% vs. 42%, p=0.0002)
Table 2: Risk factors for hypoglycemia and their association with dextrose gel treatmentIDM- Infants of gestational diabetes mellitus mothers; A1GDM- Diet controlled gestational diabetes mellitus; A2GDM- Medication managed gestational diabetes mellitus; LGA- Large for gestational age; SGA- Small for gestational age; * p value < 0.05