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Neonatal Follow-up

NICU Follow Up and Neurodevelopmental 2: Neonatal Growth, Nutrition and the Brain

209 - Dextrose Gel Prophylaxis for Neonatal Hypoglycaemia and Neurocognitive Function at Early-School-Age: a Randomised Dosage Study

Friday, April 28, 2023

5:15 PM – 7:15 PM ET

Poster Number: 209
Publication Number: 209.144

Xingyu Wei, the University of Auckland, Auckland, Auckland, New Zealand; Jane E. Harding, Liggins Institute, University of Auckland, Auckland, Auckland, New Zealand; Christopher JD. McKinlay, University of Auckland, Auckland, Auckland, New Zealand; Greg Gamble, Liggins Institute, University of Auckland, Auckland, Auckland, New Zealand; Jane M. Alsweiler, Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, Auckland, New Zealand; Nike Franke, University of Auckland, Auckland, Auckland, New Zealand; Jenny Rogers, Liggins institute, Auckland, Auckland, New Zealand; Trecia A. Wouldes, The University of Auckland, Auckland, Auckland, New Zealand; Gavin T. L.. Brown, The University of Auckland, Auckland, Auckland, New Zealand; Ben Thompson, University of waterloo, Waterloo, ON, Canada; Caroline Crowther, Liggins Institute, University of Auckland, Auckland, Auckland, New Zealand

Presenting Author(s)

Xingyu Wei, MA (she/her/hers)

PhD student
the University of Auckland
Auckland, Auckland, New Zealand

Background: Prophylactic buccal dextrose gel reduces the risk of neonatal hypoglycemia in late preterm and term infants but its effects on neurodevelopment have been conflicting, with both benefit and harm reported at 2 years. We assessed neurocognitive function at early school age in children in the pre-hPOD Dosage Trial.

Objective: To determine if prophylactic 40% dextrose gel, compared with placebo, for prevention of neonatal hypoglycemia improves neurocognitive, health and growth outcomes at 6-7 years’ corrected age, including assessment of dose-response.

Design/Methods: Infants at risk of hypoglycemia (diabetic mother, small, large, late preterm) were randomised after birth to one of four dosage arms of 40% dextrose gel: 200mg/kg once, 400mg/kg once, 200mg/kg for four doses (800mg/kg) or 400mg/kg once and 200mg/kg for three doses (1000mg/kg) or equivolume placebo. At 6-7 years’ corrected age children were assessed for executive function, language, episodic memory and motor function using the NIH Toolbox; visual perception by motion coherence; emotional-behavioural regulation with the Strength and Difficulties Questionnaire; general health and wellbeing with the Child Health Questionnaire; and measures of cardiometabolic function. The primary outcome was neurocognitive impairment, defined as a standard score < 85 in one or more Toolbox tests. Secondary outcomes included components of the primary outcome, composite cognitive score, low numeracy, motion coherence threshold, emotional-behavioural difficulty, low physical functioning, low psychosocial functioning, and overweight or obesity. Dextrose gel groups were compared to a combined placebo group, adjusted for site, risk factor for hypoglycemia, socioeconomic status and gestation length, with Dunnett family-wise error correction (α=0.05). Dose-response was assessed by linear trend.

Results: Of 392 eligible children, 308(79%) were assessed for the primary outcome. There were no significant differences in the rate of neurocognitive impairment between the combined placebo group and the dextrose gel groups (Table). There was some evidence that children exposed to multiple dextrose doses may have lower risk of overweight or obesity (placebo 44%, single 200mg/kg 52%, single 400 mg/kg 45%, multiple 800mg/kg 36%, multiple 1000mg/kg 30%; linear trend P=0.03). Placebo and dextrose gel groups were similar for other secondary outcomes.

Conclusion(s):

Prophylactic dextrose gel for neonatal hypoglycemia does not appear to alter neurocognitive impairment at early school-age.