Massaging the sugary gel into babies’ mouths may lessen need for intravenous infusions
Newborns with low blood sugar face the prospect of a trip to the intensive care unit and intravenous infusions of glucose. A new study finds a simpler way: rubbing a sweet gel onto the insides of babies’ cheeks. The inexpensive approach could stabilize blood sugar without having to separate moms from new babies.
Low blood sugar in newborns, or neonatal hypoglycemia, occurs when the tiny body needs more glucose to meet energy needs than is available in the bloodstream. Prolonged hypoglycemia risks neurological injury.
Low blood glucose shows up in 5 to 15 percent of otherwise healthy newborns as measured by blood tests. Doctors typically don’t run the analysis on every newborn, says Tonse Raju, a neonatologist at the National Institute of Child Health and Human Development in Bethesda, Md. If they spot low blood sugar symptoms such as poor color, seizures, irritability, lethargy, jittery behavior and a lack of interest in feeding, doctors are more likely to call for the blood test.
But many infants with low blood glucose don’t have such symptoms, so in 2011 the American Academy of Pediatrics offered a practical guide that pediatricians can use in deciding which infants to screen. The report designates at-risk infants as those who are born preterm, have diabetic mothers, or are either large or small for their gestational age.
In the new study, the researchers identified 237 apparently healthy newborns who had one of those risk factors or who were feeding poorly. Half of the babies were randomly assigned to get a gel made of dextrose, a form of glucose, rubbed on the inner cheeks up to six times over 48 hours; the rest received a placebo gel.
During the following week, 30 babies getting the placebo gel were placed in intensive care for hypoglycemia while only 16 of those getting the dextrose gel needed such care for the condition, the researchers report September 25 in the Lancet. The intensive care unit is best avoided since it keeps an infant away from its mother in the critical early hours of life and can interfere with bonding or breastfeeding, says study coauthor Jane Harding, a neonatologist at the University of Auckland in New Zealand. At two weeks of age, 15 babies who had received the placebo gel needed formula whereas only five in the dextrose group did, suggesting the dextrose was less likely to hinder breastfeeding.
“Babies receiving dextrose received less other intervention,” Harding says. “That made them less tampered with and meant more time with their mothers.”
Dextrose had been tried in the 1990s as an oral rub for infants but wasn’t fully tested or put into widespread use, Neil Marlow of University College London writes in the same Lancet issue. “We now have high-quality evidence that it is of some value.”
D.L. Harris et al. Dextrose gel for neonatal hypoglycaemia (the Sugar Babies Study): a randomised, double-blind, placebo-controlled trial. Lancet. Published online September 25, 2013. doi:10.1016/S0140-6736(13)61645-1.
N. Marlow. Treatment of blood glucose concentrations in newborn babies. Lancet. Published online September 25, 2013. doi:10.1016/S0140-6736(13)61755-9.
D.H. Adamkin and Committee on Fetus and Newborn. Clinical report – postnatal glucose homeostatis in late-preterm and term infants. Pediatrics. Vol. 127, March 1, 2011, p. 575. doi: 10.1542/peds.2010-3851.
W.W. Hay et al. Knowledge gaps and research needs for understanding and treating neonatal hypoglycemia: workshop report from Eunice Kennedy Shriver National Institute of Child Health and Human Development. Journal of Pediatrics. Vol. 155, November 2009, p. 612. doi: 10.1016/j.jpeds.2009.06.044.