Buccal 50% dextrose raised glucose in hypoglycaemic newborns but did not cut IV dextrose

Design

Multicentre, randomised, double-blind, placebo-controlled

Population

400 neonates ≥34 weeks with persistent asymptomatic hypoglycaemia

Primary outcome

Need for IV dextrose

Effect

4.9% vs 8.7% (p = 0.18)

A double-blind, placebo-controlled trial at two high-risk nurseries in Bangkok randomised 400 at-risk neonates of 34 weeks' gestation or more whose blood glucose stayed below threshold 30 minutes after the first feed. They received buccal 50% dextrose (200 mg/kg, 0.4 mL/kg) or placebo, followed by a feed.

The proportion needing IV dextrose was 4.9% with dextrose and 8.7% with placebo, a difference that was not statistically significant (p = 0.18). Glucose rose more with dextrose (median 28 vs 22.5 mg/dL). No hyperglycaemia, choking, vomiting or mucosal irritation was seen.

Forty per cent dextrose gel is the recommended buccal option but is not always available. This trial suggests a 50% solution is safe and raises glucose, but it did not show the outcome that matters most. The trial may also have been underpowered for a difference of this size.

• Buccal 50% dextrose raised glucose without observed adverse effects in this trial.
• It did not significantly reduce IV dextrose use; feeding remains the core intervention.
• Small- and large-for-gestational-age infants had smaller glucose responses; monitor them closely.
• Where 40% gel is available, use it as the established buccal option.

Why it matters

Many nurseries lack the recommended gel, and a substitute must be judged on whether it keeps babies with their mothers.

Don't overread it

A non-significant difference in a 400-infant trial is not proof of no effect; the trial may simply have been too small.

The statistics, in plain English

A p-value of 0.18 means a difference this size could plausibly be chance. With few infants needing IV dextrose in either group, the trial had limited power to show a real reduction.

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