Should formula vs. control be used for treating neonatal hypoglycaemia?

Formula may be considered as a treatment option for babies diagnosed with neonatal hypoglycaemia. [Conditional recommendation]

Low to very low certainty of evidence shows large to moderate effect of formula on the correction of neonatal hypoglycaemia, and reduction in recurrent hypoglycaemia.

The cost of formula for treatment of hypoglycaemia is likely comparable to that of dextrose gel and significantly lower than intravenous dextrose. Formula is widely available, but acceptability varies among different populations.

Use of formula as a treatment option for neonatal hypoglycaemia could help reduce the need for intravenous dextrose, which is more invasive, costly, and commonly involves NICU admission, with associated economic, emotional and social costs.

Consider giving formula 5 to 7 ml/kg as an alternative to intravenous dextrose for babies whose hypoglycaemia persists after two doses of dextrose gel plus breastfeeding.

Whānau should be fully informed about the risks and benefits of both treatment options and be involved in joint decision making.

Ensure that formula is readily available in clinical settings with appropriate protocols to manage the supply and administration of formula as a treatment option for neonatal hypoglycaemia.

Carers should ensure that formula use does not undermine breastfeeding efforts, offering guidance to mothers on how to maintain or transition back to breastfeeding after the hypoglycaemia is corrected. Encourage mothers to express breast milk when formula is given as treatment to maintain breast milk supply.

Repeat blood glucose concentration testing 60 minutes after administering the formula. Do not repeat formula if blood glucose concentration is ≥2.6 mmol/L. If the repeat blood glucose concentration is <2.6 mmol/L, prompt referral is required for consideration of intravenous dextrose.

Studies are needed on:

1. Effect of formula compared to intravenous dextrose or donor human milk on correcting neonatal hypoglycaemia, NICU admission rates, and breastfeeding at hospital discharge.
2.  The cultural acceptability to whānau of using formula for the treatment of neonatal hypoglycaemia.
3. The optimal amount of formula to be given for the treatment of neonatal hypoglycaemia.
4. The long-term neurological effects on infants treated with formula for neonatal hypoglycaemia.

Communication strategies should be adapted to align with the cultural values and preferences of whānau, particularly in communities where breastfeeding is strongly preferred. Whānau should be fully informed about the advantages and disadvantages of using formula as a treatment for hypoglycaemia.