Satyan Lakshminrusimha, MD

Satyan Lakshminrusimha found that administering a dose of dextrose gel inside a newborn’s cheek addresses low sugar levels better than feedings alone.

Hypoglycemic Newborns Benefit from Dextrose Gel, UB Study Finds

Published March 30, 2017

Giving oral dextrose gel to hypoglycemic newborns reduces the need for IV fluids, alleviating health care costs while promoting bonding and breast-feeding, says Satyan Lakshminrusimha, MD, professor and vice chair of pediatrics and chief of the Division of Neonatology.

“Birthing is stressful enough. It’s further upsetting to a mother — especially a first-time mother — if she is not able to breast-feed because her baby needs IV therapy due to low glucose.”
Professor and vice chair of pediatrics, chief of neonatology

Treatment Reduced NICU Admissions

Conducting their research at Women and Children’s Hospital of Buffalo (WCHOB), Lakshminrusimha and colleagues found that giving the gel to at- or near-term babies with low blood sugar reduced admissions to the Newborn Intensive Care Unit (NICU) for hypoglycemia from 42 to 26 percent.

In 74 percent of babies, the gel successfully addressed low blood sugar versus only 58 percent of babies who had received regular feedings alone before the hospital began implementing the gel into its hypoglycemia protocol.

The researchers reported their findings in Karger Biomedicine Hub.

Lakshminrusimha and collaborator Praveen K. Chandrasekharan, MD, research assistant professor of pediatrics, also co-authored a commentary, published in British Medicine Journals’ Evidence-Based Medicine, on related research in New Zealand.

Low Glucose May Hinder Bonding

Hypoglycemia in newborns is becoming more common worldwide, a result of an increasing number of overweight, obese or diabetic mothers.

These babies may be treated with supplementary formula or, if that fails, intravenous fluids, requiring mother and child to be separated for hours and even days at a time. Both treatment options interfere with bonding and reduce the chance that a mother will breast-feed exclusively once she’s home.

“Birthing is stressful enough,” Lakshminrusimha says. “It’s further upsetting to a mother — especially a first-time mother — if she is not able to breast-feed because her baby needs IV therapy due to low glucose.”

Gel Higher in Sugar than Milk, Formula

The UB study highlights a drawback of treating hypoglycemic newborns with feedings alone.

“Dextrose gel is used in adult diabetics all the time, while in babies the protocol was just to do feedings,” Chandrasekharan explains. “There is sugar in milk, but 100 milliliters of breast milk or formula has only 7 grams of sugar, while 100 milliliters of gel has 40 grams.”

The dextrose gel — a dose of which is swabbed inside a baby’s cheek — improves the level of breast-feeding when mothers are discharged from the hospital and reduces health care costs, Chandrasekharan adds.

“Previously, if the baby didn’t get better after three feeds, they automatically were admitted to the NICU.”

Journal Club Prompts Protocol Change

WCHOB and Millard Fillmore Suburban Hospital began incorporating dextrose gel into their hypoglycemia protocol for newborns in 2014 — a direct result of a UB journal club discussion about findings that this noninvasive approach could effectively address the condition, Lakshminrusimha points out.

“Journal club is one of the forums where UB medical faculty share ideas that may end up directly benefiting our patients,” he says. “As an academic health center, we see it as part of our mission to keep abreast of cutting-edge research so we can spread the benefits of research to the rest of our community.” 

Lakshminrusimha facilitated the journal club discussion with Munmun Rawat, MD. Then a trainee in UB’s neonatal-perinatal fellowship — and soon to be a UB faculty member in pediatrics — Rawat served as first author on the Biomedicine Hub paper.

The hypoglycemia protocol described in the paper was revised by Stephen J. Turkovich, MD, clinical assistant professor of pediatrics, with input from the Division of Endocrinology and Diabetes, led by Teresa Quattrin, MD, UB Distinguished Professor and chair of pediatrics.

Approach Sparks Interest Around U.S.

When Chandrasekharan presented findings on the UB research at last spring’s meeting of the Pediatric Academic Societies, the response was overwhelming, he says.

So many participants attended the session that an overflow conference room had to be opened.

Interest in the new protocol continues to spread, with the UB researchers receiving requests for information from institutions in Texas, Colorado, Georgia, Connecticut and elsewhere in New York State.

Spurring New Prevention Strategies

The research on dextrose gel is leading to new ways to prevent hypoglycemia, say the UB researchers.

The New Zealand team reported positive results on preventively treating newborns at risk for hypoglycemia — such as infants of diabetic mothers — with one dose of oral dextrose.

In their commentary on that study, Lakshminrusimha and Chandrasekharan described it as “a novel approach that requires further investigation.”