Do not give routine prophylactic dextrose gel to at-risk newborns

Design

School-age follow-up of a multicentre, double-blind, placebo-controlled RCT

Population

1,067 children born at ≥35 weeks with risk factors for neonatal hypoglycaemia

Primary outcome

Neurocognitive impairment at 6–7 years

Effect

59% vs 57%; adjusted risk difference 3% (95% CI −3% to 9%)

The hPOD trial in nine New Zealand hospitals randomised at-risk late preterm and term newborns — preterm, maternal diabetes, small or large for gestational age — to a single 0.2 g/kg dose of buccal dextrose gel or placebo at one hour of age. This school-age follow-up assessed 1,067 children (82–83% of those eligible) at 6–7 years.

Neurocognitive impairment was similar: 59% after gel and 57% after placebo (adjusted risk difference 3%, 95% CI −3% to 9%). Among exploratory outcomes, children who had received gel were more likely to have emotional-behavioural difficulty (24% vs 18%) and low psychosocial function (17% vs 12%).

The exploratory findings need confirmation, but there is no longer-term benefit to set against them. The authors conclude the evidence does not support routine prophylactic gel. Dextrose gel as a treatment for established hypoglycaemia is a different question and is not addressed here.

• Stop routine prophylactic dextrose gel for at-risk newborns if your unit uses it.
• Continue to use dextrose gel as treatment for confirmed hypoglycaemia where your protocol supports it.
• Prioritise early feeding and timed glucose monitoring in at-risk babies.
• Share this evidence with obstetric and midwifery teams who may start gel at delivery.

Why it matters

It removes a preventive intervention that many units adopted, with a hint that it may do harm.

Don't overread it

The wellbeing harms were exploratory outcomes; the trial does not address gel used as treatment.

The statistics, in plain English

The adjusted risk difference of 3% with a confidence interval from −3% to 9% means no detectable benefit and a possible small harm. The emotional-behavioural results were exploratory among 11 outcomes, so one or two could be chance findings, but they point the same way.

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