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Scientific research


Neonatal hypoglycaemia is common, and a preventable cause of brain damage. Dextrose gel is used to reverse hypoglycaemia in individuals with diabetes; however, little evidence exists for its use in babies. We aimed to assess whether treatment with dextrose gel was more effective than feeding alone for reversal of neonatal hypoglycaemia in at-risk babies.

We undertook a randomised, double-blind, placebo-controlled trial at a tertiary centre in New Zealand between Dec 1, 2008, and Nov 31, 2010. Babies aged 35-42 weeks’ gestation, younger than 48-h-old, and at risk of hypoglycaemia were randomly assigned (1:1), via computer-generated blocked randomisation, to 40% dextrose gel 200 mg/kg or placebo gel. Randomisation was stratified by maternal diabetes and birthweight. Group allocation was concealed from clinicians, families, and all study investigators. The primary outcome was treatment failure, defined as a blood glucose concentration of less than 2·6 mmol/L after two treatment attempts. Analysis was by intention to treat. The trial is registered with Australian New Zealand Clinical Trials Registry, number ACTRN12608000623392.

Of 514 enrolled babies, 242 (47%) became hypoglycaemia and were randomised. Five babies were randomised in error, leaving 237 for analysis: 118 (50%) in the dextrose group and 119 (50%) in the placebo group. Dextrose gel reduced the frequency of treatment failure compared with placebo (16 [14%] vs 29 [24%]; relative risk 0·57, 95% Cl 0·33-0·98; p=0-04). We noted no serious adverse events. Three (3%) babies in the placebo group each had one blood glucose concentration of 0·9 mmol/L. No other adverse events took place.

Treatment with dextrose gel is inexpensive and simple to administer. Dextrose gel should be considered for first-line treatment to manage hypoglycaemia in late preterm and term babies in the first 48 hours after birth.

Read the full article in The Lancet.


A following research (Cost Analysis of Treating Neonatal Hypoglycaemia with Dextrose Gel), published in The Journal of Pediatrics (Glasgow, et al., 2018) supports the use of dextrose gel on economic grounds:


In the primary analysis, treating neonatal hypoglycaemia using dextrose gel had an overall cost of NZ$ 6.863,81 and standard care (placebo) cost NZ$ 8.178,25; a saving of NZ$ 1.314,44 (approx. € 790,-) per infant treated. Sensitivity analyses showed that dextrose gel remained cost saving with wide variations in dextrose gel costs, neonatal intensive care unit casts, caesarean delivery rates, and casts of monitoring.


Use of buccal dextrose gel reduces hospital costs for management of neonatal hypoglycaemia. Because it is also non-invasive, well tolerated, safe, and associated with improved breastfeeding, buccal dextrose gel should be routinely used for initial treatment of neonatal hypoglycaemia.

Read the full article in The journal of Pediatrics.


Prof. Dr. Irwin Reiss

Head of department of Neonatology Erasmus MC

(Click on video below)


Dr. Sinno Simons

Neonatologist Erasmus MC

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