GP268 Impact of the Use of Oral Dextrose Gel for Neonatal Hypoglycaemia and Admission Rates to Neonatal Units: a Systematic Review and Meta-Analysis

Background Neonatal hypoglycaemia (NH) is a leading cause of admission to neonatal units. It affects 15% of newborn infants and 50% have risk factors. Dextrose gel (40%), often described as oral gel, can be administered to buccal mucosa and lingual surfaces of infant’s mouth resulting in a rapid absorption into the circulation. Rawat et al. (2016) recommended that treatment with dextrose gel is noninvasive, inexpensive and easy to administer. Objective To ascertain the impact of 40% dextrose oral gel on documented neonatal hypoglycaemia in the postnatal wards to prevent neonatal admission rates. Method A systematic review (SR) of quantitative studies in medical databases including; Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase and SCOPUS were searched in February 2018. Grey literature was searched for full-text conference papers in Irish Health Repository (LENUS) and the National Institute for Health and Care Excellence (NICE) inclusions. Using combinations of the relevant key words incorporating the PICO model (‘dextrose gel’, ‘glucose gel’, ‘neonate’, ‘newborn’, ‘hypoglycaemia’ and ‘admission’), review was performed and English language limitation was applied. Quantitative studies that did not measure neonatal admission rates were excluded. Search results were reported following the PRISMA guidelines. Data from eligible studies were synthesized for a meta-analysis. A dichotomous analysis was preformed through Review Manger 5 software (RevMan® 5.3) to give a forest plot and funnel plot on the primary outcome as admission rates to a neonatal unit. Results The search yielded 130 papers, including 128 from database search and two from grey literature. 21 duplicates were removed leaving 109 papers for screening and of these 19 full text articles were eligible for initial review. Five studies were identified fulfilling the predetermined criteria and included for analysis. Two randomised control trials (RCT’s) were analysed and the meta-analysis shows that the use of 40% dextrose gel for neonatal hypoglycaemia decreases admission rates for at risk infants. Three quantitative studies of other designs also reported a decrease in admission rates for hypoglycaemia. Increased rate of exclusive breastfeeding was also consistently linked to the use of oral application of dextrose gel across the five studies. Conclusion Dextrose gel (40%) as an oral mucosal application can be safely and effectively used as a method of treating neonatal hypoglycaemia in at risk infants in the postnatal wards, thus reducing admission to the neonatal unit. Secondary benefits of reduced mother-infant separation and improved breastfeeding also were noted.