by Anne Eglash MD, IBCLC, FABM
Does the use of buccal (in the cheek) 40% glucose gel for treatment of asymptomatic newborn hypoglycemia have an effect on breastfeeding rates?
Immediately after an infant’s birth, the infant’s blood sugar naturally drops (hypoglycemia). Healthy term newborns have hormonal and metabolic processes to prevent becoming hypoglycemic until they can access calories from their mother. Many infants have a higher risk of low blood sugar in the first several hours of life, such as ill or premature infants, those small/large for gestational age, or infants of diabetic mothers, among many others. For infants at risk, routine blood sugar screening starts a few hours after birth.
Buccal 40% glucose gel has become a widely-used alternative in hospitals for newborns who have a low blood sugar, but who don’t have any symptoms of hypoglycemia, such as weakness or jitteriness. Using glucose gel is thought to prevent supplementing these babies with bottles of formula, as long as they can continue to breastfeed.
The authors of a recent systematic review evaluated several studies to determine the effect of glucose gel on separation of mother and infant, breastfeeding rates, neurodevelopment, and parental satisfaction.
What do you think the authors found regarding the use of buccal 40% glucose gel on breastfeeding rates? (choose 1 or more):
- Breastfeeding rates at 4 months and 6 months postpartum are increased if glucose gel is used to treat asymptomatic hypoglycemia.
- Use of glucose gel for asymptomatic hypoglycemia leads to less in-hospital formula supplementation.
- Use of glucose gel for asymptomatic hypoglycemia is associated with higher breastfeeding rates at hospital discharge.
- Use of glucose gel is associated with less maternal-infant separation, and improved skin –to-skin rates.
See the Answer
B,C,D (not A)
Read the Abstract: Adv Neonatal Care. 2017 Aug 29.
Glucose Gel as a Treatment Strategy for Transient Neonatal Hypoglycemia.
BACKGROUND
Transient asymptomatic neonatal hypoglycemia (TANH) is common as infants transition from their mother’s energy stores to their own. There is little evidence supporting the blood glucose threshold that indicates a need for treatment although sustained hypoglycemia has been correlated with negative neurodevelopmental consequences. Treatment of TANH includes a stepwise approach from supplemental enteral feedings, buccal glucose gel, intravenous dextrose infusion, and/or transfer to special care units including neonatal intensive care units.
PURPOSE
The purpose of this evidence-based practice brief is to review current evidence on 40% buccal glucose gel administration as a treatment strategy for TANH.
METHODS/SEARCH STRATEGY
CINAHL, Cochrane, Google Scholar, and PubMed were searched using the key words and restricted to English language over the last 7 years.
FINDINGS/RESULTS
The use of buccal dextrose gel for TANH may reduce neonatal intensive care unit admissions, reduce hospital length of stay and cost, support the mother-infant dyad through reduced separation, support exclusive breastfeeding, and improve parental satisfaction without adverse neurodevelopmental consequences.
IMPLICATIONS FOR PRACTICE
Timely collection of blood glucose levels following intervention is critical to support clinical decisions. Clinicians should offer family education regarding the rationale for serial glucose monitoring and treatment indications including buccal glucose administration. Clinical protocols can be revised to include use of buccal dextrose gel.
IMPLICATIONS FOR RESEARCH
There is a need for rigorous long-term studies comparing treatment thresholds and neurodevelopmental outcomes among various treatment strategies for TANH.
Milk Mob Comment By Anne Eglash MD, IBCLC, FABM
So far, the American Academy of Pediatrics and the Academy of Breastfeeding Medicine protocols have not incorporated the use of buccal 40% glucose gel into their newborn hypoglycemia protocols, but perhaps they will with their next revisions since the evidence for it use and safety appears strong.
As a reminder, buccal glucose gel is not recommended for infants who have symptoms of low blood sugar, such as weakness or jitteriness. Those infants need a higher level of care and intravenous glucose.
So many of us have worked with infants who refused to breastfeed after receiving bottles of formula for low blood sugar in the first few hours of life. It can take weeks to months for some of these infants to latch, and some will never breastfeed, often because of other complications stemming from mothers having to exclusively pump. It seems safe to assume that if glucose gel improves breastfeeding rates at discharge, breastfeeding rates at 4-6 months will also improve, but we just don’t have the data to claim this yet. Because there are so many factors that determine postpartum breastfeeding rates, it has been hard to tease out the effect of glucose gel for neonatal hypoglycemia.
Denyse Schroeder
Dr.Eglash, Is there a way to access the research on this topic??
Heidi
Very useful information. Thank you
Laurene
Thanks, it’s quite informative