Effect of Prophylactic Dextrose Gel on Continuous Measures of Neonatal Glycemia: Secondary Analysis of the pre-hPOD Trial.

OBJECTIVE: To determine the effects of different doses of prophylactic dextrose gel on glycemic stability assessed using continuous interstitial glucose monitoring (CGM) in the first 48 hours when given to babies at risk of neonatal hypoglycemia.

STUDY DESIGN: CGM was undertaken for the first 48 hours in 133 infants at risk of hypoglycemia who participated in the pre-hPOD randomized dosage trial of dextrose gel prophylaxis.

RESULTS: Low glucose concentrations were detected in 41% of infants by blood glucose monitoring and 68% by CGM. The mean (SD) duration of low interstitial glucose concentrations was 295 (351) minutes in the first 48 hours. Infants who received any dose of dextrose gel appeared less likely than those who received placebo gel to experience low glucose concentrations (<47mg/dl [2.6mmol/l], p=0.08), particularly if they received a single dose of 200mg/kg (RR 0.70, 95% CI 0.50-0.10, p = 0.049). They also spent a larger proportion of time in the central glucose concentration range of 54 to 72 mg/dl [3 to 4 mmol/l] (any dose: mean (SD) 58.2 (20.3)%; placebo: 50.0 (21.9)%, mean difference 8.20%; 95% CI 0.43-15.9%, p = 0.038). Dextrose gel did not increase recurrent or severe episodes of low glucose concentrations and did not increase the peak glucose concentration. These effects were similar for all trial dosages.

CONCLUSIONS: Low glucose concentrations were common in infants at risk of hypoglycemia despite blood glucose monitoring and treatment. Prophylactic dextrose gel reduced the risk of hypoglycemia without adverse effects on glucose stability.