GLUCOSE GEL USE FOR NEONATAL HYPOGLYCEMIA: RISK STRATIFICATION AND CLINICAL EFFECTIVENESS
M. Pearce MD¹, M. Connolly MD¹, A. Waldeck PharmD BCPS¹, S. Sterlin MS, RNC-OB, C-EFM, CBC¹, S. Sridhar MD¹
¹Department of Pediatrics, Division of Neonatology. Stony Brook Children's
Renaissance School of Medicine at Stony Brook University, Stony Brook, NY
Introduction: Neonatal hypoglycemia occurs in 15-25% of late preterm/term infants in the immediate neonatal period with known associations between severe/persistent hypoglycemia and neurodevelopmental deficits. Guidelines exist for management of at risk infants however the definition and optimal management strategies continue to be debated. Oral glucose gel offers a treatment option during the often transient hormonal regulation adjustments to maintain euglycemia. The aim is to review the clinical effectiveness of glucose gel based on infant demographics and identified risk factors.
Methods: EPOCH 2 reviewed data from late preterm/term infants who received oral glucose gel for hypoglycemia in L&D or newborn nursery. Gel administration, feeding characteristics and clinical effects were compared based on identified risk factors. EPOCH 1 previously reviewed NICU admission rates in a pre/post intervention timeframe after implementing glucose gel use.
Results: 375 infants with a mean gestational age of 38 5/7 weeks and birth weight of 3264 g received glucose gel. Nearly two-thirds were male, whom trended towards delivery by c/s, being breast fed, requiring more NICU admissions and IV fluids despite containing more term infants (p 0.05). 266 (49%) of gels were administered in ≤15 min and 273 (51%) in >15 min, however no difference in blood glucose increase or NICU admission rate was seen. 33 (9%) infants received 3-4 gels and more often required NICU admission (48% vs 20%, p <0.001) with no difference in IV requirement or length of stay (LOS). Exclusively breastfed infants less frequently required NICU admission, and when so had a shorter LOS.
69 (19%) SGA infants and 80 (21%) LGA infants were independently compared to 226 (60%) AGA infants. SGA were more often term and less frequently infants of diabetic mothers (IDM) (p≤ 0.05). They required more NICU admission (p 0.04) with longer LOS and duration of IV (p<0.001). Both SGA and LGA were more often admitted from L&D (p≤0.03) and more were exclusively formula fed (p <0.01). Infants exposed to beta blockers and IDM (insulin/oral meds) trended towards more frequent NICU admission, longer IV duration and LOS.
Conclusion: Risk stratification may provide pertinent information as to which infants may develop significant/persistent hypoglycemia and ultimately require IV dextrose and prolonged monitoring. Glucose gel use leads to less NICU admissions and improved breast feeding rates, however, in our study cohort, the use of more than 2 gels in high risk infants showed a trend toward NICU admission, IV dextrose requirement and prolonged length of stay.
