Should intravenous dextrose vs. other treatment or no treatment be used for treatment of neonatal hypoglycaemia?

Intravenous (IV) dextrose should be given if blood glucose concentration remains < 2.6 mmol/L despite treatment with increased feeding and buccal dextrose gel. Do not give an initial bolus of IV dextrose routinely. [Conditional recommendation]

Using IV dextrose is typically reserved for cases where oral treatment options have been exhausted, but there is very little evidence of benefits and harms.

There is some evidence that treatment of hypoglycaemic babies with an IV bolus is associated with more rapid change in blood glucose concentrations, including increased incidence of high glucose concentrations, and that these are associated with adverse neurodevelopmental outcomes.

One before-and-after study showed that tailoring the dose of IV dextrose and use of an initial bolus depending on the glucose concentration resulted in similar time to resolution of hypoglycaemia but shorter NICU stay and reduced costs.

While IV dextrose itself is inexpensive, the costs associated with NICU care, including administration and staffing, can be significant.

The panel considered that evidence from randomised trials of IV dextrose compared to oral sucrose were not relevant when formulating this recommendation.

Start treatment with 30-60ml/kg/d 10% dextrose. Continue feeding if possible.

Consider an initial bolus of 1-2ml/kg of 10% dextrose over 10min only if the initial blood glucose concentration is very low (< 1 mmol/L) or the baby has severe symptomatic hypoglycaemia (seizures or reduced consciousness).

It is important to have an open and honest discussion with parents about the uncertainty regarding the benefits of IV dextrose.

Check blood glucose concentration after 1 hour and adjust infusion rate as necessary.

Continue regular monitoring of blood glucose concentrations during IV treatment.

Studies are needed on:

1. The effects of IV dextrose bolus administration on short and longterm outcomes.
2. The optimal dosage and methods for administering IV dextrose.
3. The optimal strategies for weaning babies off IV dextrose and onto full oral feeds.

IV treatment may not be available at all healthcare facilities, so may worsen inequities for those with limited access. Ensure that all babies at risk of neonatal hypoglycaemia and their whānau have prompt access to facilities that can provide IV treatment if needed.