Are babies given prophylactic oral dextrose gel less likely to develop neonatal hypoglycaemia?

Oral dextrose gel should not be given routinely to at-risk babies to prevent neonatal hypoglycaemia. [Conditional recommendation]

Prophylactic oral dextrose gel reduces the risk of neonatal hypoglycaemia in at‐risk babies but does not reduce NICU admission or need for intravenous treatment. It may make little to no difference to the risk of neurodevelopmental impairment at two years, but the confidence intervals include the possibility of substantial benefit or harm. Evidence at six to seven years is limited to a single small study.

In view of its limited short‐term benefits, and potential applicability to a very large proportion of all newborn babies (approximately 30%), prophylactic oral dextrose gel should not be incorporated into routine practice until additional information is available about the balance of risks and harms for later neurological disability.

Consider offering prophylactic dextrose if risk of hypoglycaemia is considered to be high by practitioner or family and they are well-informed about available evidence, including benefits and risks.

Draw up the prescribed dose (0.5ml/kg or 200 mg/kg 40% dextrose gel) into an enteral syringe and administer at 1 hour of age, using the procedures as for dextrose gel treatment (see recommendation 22).

Prophylactic dextrose gel can be given to a baby while having skin-to-skin care.

All babies at risk of hypoglycaemia require clinical monitoring and testing for hypoglycaemia, whether or not they have received prophylactic dextrose gel.

Studies are needed on:

1. Effect of prophylactic oral dextrose gel for neonatal hypoglycaemia on later neurological disability.
2. The effectiveness of prophylactic oral dextrose gel compared to other preventative interventions such as harvested colostrum, donor milk or infant formula.

Māori, Pacific, and Asian whānau are likely to accept oral dextrose gel treatment, especially if the mother has experienced diabetes. Discuss with whānau if they have cultural practices that are important to carry out following the birth, and support this to be woven into care together with clinician activities. Harm occurs when health professionals do not engage with whānau about their cultural preferences.