Authors (including presenting author) :
Lee WM(1), Yeung LM(2), Wong MSC(1), Woo KM (1), Tam C(2), Yip MK(2), Jalal K(1), Shek WMN(2)
Affiliation :
(1)Department of Paediatrics & Adolescent Medicine, Queen Mary Hospital (2)Department of Obstetrics and Gynaecology, Queen Mary Hospital
Introduction :
Transient asymptomatic hypoglycemia is commonly seen in newborns as they transit from their mother’s energy stores to their own after delivery. It reflects normal extra-uterine life adaption. Most newborns adapt well with responsive breastfeeding. Some newborns, who are premature, small- or large- for gestation or newborns of diabetic mothers are at risk of developing hypoglycaemia with impaired counter-regulatory response. Neurologic sequelae could occur in prolonged or severe hypoglycaemia left untreated. There is no specific plasma glucose concentration or hypoglycaemia duration could predict acute symptoms or sustained neurologic injury. Nevertheless, prompt intervention is necessary if there is manifestation of clinical signs and symptoms of hypoglycaemia. Conventional treatment relies on infant formula when maternal breast milk supply has not yet established well in the first few days after delivery. The use of formula to treat hypoglycemia has the potential to jeopardize exclusive breastfeeding. If separation is required for monitoring in special care baby or neonatal intensive care unit, mother-newborn bonding would be negatively impacted. Growing evidence suggests the use of buccal dextrose gel as a safe treatment alternative to infant formula for transient neonatal hypoglycaemia. The neonatal and obstetrics team in a tertiary centre developed a guideline for the prevention and management of neonatal hypoglycaemia with the pilot use of 40% buccal dextrose gel administration as an alternative treatment strategy since 17 August 2020.
Objectives :
To reduce maternal-newborn separation in newborns with hypoglycaemia with the pilot use of 40% buccal dextrose gel.
Methodology :
At-risk newborns were identified upon delivery. Their mothers were introduced the pilot treatment strategy using buccal dextrose gel for neonatal hypoglycaemia. They could opt for using dextrose gel or infant formula. A retrospective record review for the pilot treatment strategy at the first month after its implementation from 17 August to 17 September 2020.
Result & Outcome :
22 newborns were identified as at-risk of developing neonatal hypoglycaemia in the study period. Among them, 12 were large-for-gestation, 6 were small-for-gestation, 3 late preterm and 1 newborn with diabetics’ mother. 11 of the newborns required treatment to correct hypoglycaemia. Among 6 of them whose mother opted 40% buccal dextrose gel, only 1 required special care baby unit admission. 5 of them remained rooming-in with their mothers without separation.
