Incorporating dextrose gel and feeding in the treatment of neonatal hypoglycaemia
Incorporating dextrose gel and feeding in the treatment of neonatal hypoglycaemia
复制标题
DOI：
10.1136/archdischild-2018-316430
复制
发表时间：
2020-01-01
影响因子：
4.4
通讯作者：
Sen, Sarbattama
中科院分区：
文献类型：
--
作者：
Gregory, Katherine;Turner, Daria;Sen, Sarbattama
目的探讨葡萄糖凝胶在新生儿低血糖治疗中的作用及喂养方式对低血糖结局的影响。研究设计：对2688名妊娠35周的新生儿在实施新生儿低血糖评估和治疗指南前后进行新生儿低血糖筛查的回顾性分析。结果实施指南后，需要静脉注射葡萄糖治疗NH的婴儿比例明显降低(指南实施前为8.6%，指南实施后为5.6%，P=0.007)。在整个队列中，注射凝胶后血糖浓度的中位数上升为0.61 mmol/L(11 mg/dL)(IQR0.28-1.06 mmol/L(5-19 mg/dL))。配方奶喂养的婴儿血糖浓度对喂养和凝胶的反应比母乳喂养的婴儿升高更多(p=0.0001)。在完全调整的模型中，配方奶喂养与低血糖复发的几率较低有关，根据需要第二种凝胶的定义。特别是，在PreGel血糖为2.00~2.17 mmol/L(36~39 mg/dL)的婴儿中，配方奶喂养与低血糖复发的几率较低。结论右旋糖凝胶是治疗NH的有效工具。婴儿的PreGel血糖浓度可能有助于指导有关提供的喂养类型的决定。
Objectives To determine the impact of incorporating dextrose gel in the treatment of neonatal hypoglycaemia (NH) and the role of feeding type in NH outcomes.Study design We conducted a retrospective analysis of 2688 infants >35 weeks' gestation who were screened for NH before and after implementation of a clinical guideline for NH evaluation and treatment. We analysed the proportion of infants who required intravenous dextrose for NH before and after guideline implementation, the change in blood glucose concentrations with gel by feeding type and the odds of successful NH treatment with gel and feeding by feeding type.Results Following implementation of the guideline, a lower proportion of infants required intravenous dextrose for NH treatment (8.6% (60 infants) before guideline vs. 5.6% (112 infants) after guideline (p=0.007)). The median rise in blood glucose concentration with gel administration in the entire cohort was 0.61 mmol/L (11 mg/dL) (IQR 0.28-1.06 mmol/L (5-19mg/dL)). Blood glucose concentration of formula-fed infants rose more in response to feeding and gel than breastfed infants (p=0.0001). Formula feeding was associated with a lower odds of recurrent hypoglycaemia, as defined by requiring a second gel, in a fully adjusted model. Specifically, in infants with a pregel blood glucose of 2.00-2.17 mmol/L (36-39 mg/dL), formula feeding with gel was associated with a lower odds of recurrent hypoglycaemia.Conclusions Dextrose gel is an effective tool in the treatment of NH. An infant's pregel blood glucose concentration may be helpful in guiding decisions around type of feeding provided.