What are the benefits and risks of buccal dextrose gel for babies diagnosed with neonatal hypoglycaemia?

Babies diagnosed with neonatal hypoglycaemia should be treated with 40% oral dextrose gel. [Conditional recommendation]

Moderate certainty evidence shows that buccal dextrose gel results in a large increase in correction of hypoglycaemia, moderate reduction in admission to NICU and large reduction in separation of mother and baby for treatment of hypoglycaemia. No adverse effects were reported.

Treatment is feasible as it is already being used, and acceptable to caregivers and whānau.

Gel is inexpensive, cost effective, and can be used in any care setting.

Conditional recommendation because there is no information on babies born before 34 weeks’ gestation, or effect of different doses and different timings of administration.

If baby is clinically stable and able to feed, administer 0.5 ml/kg (200 mg/kg)
40% dextrose gel.

Draw up the prescribed dose in an enteral syringe.  Dry the buccal mucosa using a gauze swab. Apply gel to the buccal mucosa in small aliquots using a gloved finger, and massage it in gently. Offer the baby a feed immediately after administering the gel.

If the blood glucose concentration is <2.0mmol/L, dextrose gel alone is unlikely to be sufficient treatment. Administer dextrose gel while arranging transfer to a facility where IV infusion is available. 

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

Repeat blood glucose concentration testing 30-60 minutes after administering dextrose gel and beginning the feed.

If the repeat blood glucose is < 2.6 mmol/L, repeat the dextrose gel and offer a feed, then test again 30-60 minutes after administering the second dose.

Continue clinical observations. If any subsequent blood glucose concentration is < 2.6 mmol/L, the clinical condition of the baby should be reviewed and referral considered for further investigation and treatment.

Studies are needed on:

1. The effect of buccal dextrose gel for treatment of neonatal hypoglycaemia on long-term neurodevelopmental impairment.
2.  The effect of buccal dextrose gel for treatment of babies born <34 weeks’ gestation.
3. The most effective dose, frequency and mode of administration of buccal dextrose gel.

Severe or symptomatic hypoglycaemia is a medical emergency. Not all babies at risk of neonatal hypoglycaemia can be identified before birth, and hypoglycaemia can occur in babies without risk factors. Dextrose gel and capacity accurately to measure blood glucose concentrations should therefore be available as standard emergency equipment wherever newborns are cared for, including in community settings. Carers need appropriate education and resourcing for this.

Provide whānau with information on health benefits and potential adverse effects of dextrose gel treatment. Whānau should also be provided with resources that align with their cultural values. Provide whānau with information on dextrose treatment in multiple mediums (e.g., written, oral, visual).