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Cochrane Database of Systematic Reviews

Gel de dextrosa oral para prevenir la hipoglucemia en neonatos en riesgo

Esta versión no es la más reciente

ver la versión actual 28 noviembre 2023

Información

DOI:
https://doi.org/10.1002/14651858.CD012152.pub2Copiar DOI
Base de datos:
  1. Cochrane Database of Systematic Reviews
Versión publicada:
  1. 24 julio 2017see what's new
Tipo:
  1. Intervention
Etapa:
  1. Review
Grupo Editorial Cochrane:

  1. Grupo Cochrane de Neonatología

Copyright:
  1. Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Autores

  • Joanne E Hegarty

    Neonatal Intensive Care Unit, Auckland Hospital, Auckland, New Zealand

    Liggins Institute, The University of Auckland, Auckland, New Zealand

  • Jane E Harding

    Correspondencia a: Liggins Institute, The University of Auckland, Auckland, New Zealand

    [email protected]

  • Caroline A Crowther

    Liggins Institute, The University of Auckland, Auckland, New Zealand

    ARCH: Australian Research Centre for Health of Women and Babies, Robinson Research Institute, Discipline of Obstetrics and Gynaecology, The University of Adelaide, Adelaide, Australia

  • Julie Brown

    Liggins Institute, The University of Auckland, Auckland, New Zealand

  • Jane Alsweiler

    Neonatal Intensive Care Unit, Auckland Hospital, Auckland, New Zealand

    Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand

Contributions of authors

Jo Hegarty wrote the first draft of the protocol and co‐ordinated and wrote subsequent drafts, with significant editorial assistance provided by JB. All review authors contributed to subsequent drafts and approved the final version.

Sources of support

Internal sources

  • Gravida: National Research Centre for Growth and Development, New Zealand.

    PhD Scholarship for Jo Hegarty

  • Auckland District Health Board, New Zealand.

    Clinical Salary for Jo Hegarty

  • Liggins Institute, University of Auckland, New Zealand.

    University appointments for Jane Harding, Caroline Crowther, Jane Alsweiler, and Julie Brown

External sources

  • Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, USA.

    Editorial support of the Cochrane Neonatal Review Group has been funded with Federal funds from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, USA, under Contract No. HHSN275201600005C

Declarations of interest

Jo Hegarty, Jane Alsweiler, Caroline Crowther, and Jane Harding are authors of the included study (Hegarty JE, Harding JE, Gamble GD, Crowther, CA, Edlin R, Alsweiler JM. Preventing neonatal hypoglycaemia with oral dextrose gel: a randomised controlled trial. PLOS Medicine 2016;13(10):e1002155) and investigators on the large ongoing study (Harding JE, Hegarty JE, Crowther CA, Edlin R, Gamble G, Alsweiler JM. Randomised trial of neonatal hypoglycaemia prevention with oral dextrose gel (hPOD): study protocol. BMC Pediatrics 2015;15(120)).

Review authors report no other conflict and in particular have received no benefits in cash or kind in relation to any element of the proposed review.

Acknowledgements

We acknowledge the support of the Cochrane Neonatal Review Group editorial office and contributions of Tineke Crawford (data extraction and risk of bias assessment) and Dr. Phil Weston, Dr. Deborah Harris, and Dr. Malcolm Battin, with whom Jo Hegarty, Julie Brown, and Jane Harding are co‐authors of the Cochrane review "Dextrose gel for the treatment of hypoglycaemia in newborn infants".

Version history

Published

Title

Stage

Authors

Version

2023 Nov 28

Oral dextrose gel to prevent hypoglycaemia in at‐risk neonates

Review

Lily Roberts, Luling Lin, Jane Alsweiler, Taygen Edwards, Gordon Liu, Jane E Harding

https://doi.org/10.1002/14651858.CD012152.pub4

2021 May 17

Oral dextrose gel to prevent hypoglycaemia in at‐risk neonates

Review

Taygen Edwards, Gordon Liu, Joanne E Hegarty, Caroline A Crowther, Jane Alsweiler, Jane E Harding

https://doi.org/10.1002/14651858.CD012152.pub3

2017 Jul 24

Oral dextrose gel to prevent hypoglycaemia in at‐risk neonates

Review

Joanne E Hegarty, Jane E Harding, Caroline A Crowther, Julie Brown, Jane Alsweiler

https://doi.org/10.1002/14651858.CD012152.pub2

2016 Apr 13

Oral dextrose gel for the prevention of hypoglycaemia in newborn infants

Protocol

Joanne E Hegarty, Jane E Harding, Caroline A Crowther, Julie Brown, Jane Alsweiler

https://doi.org/10.1002/14651858.CD012152

PICO

Population
Intervention
Comparison
Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

Study flow diagram.
Figuras y tablas -
Figure 1

Study flow diagram.

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Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figuras y tablas -
Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

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Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
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Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

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Comparison 1 Dextrose gel versus control, Outcome 1 Hypoglycaemia.
Figuras y tablas -
Analysis 1.1

Comparison 1 Dextrose gel versus control, Outcome 1 Hypoglycaemia.

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Comparison 1 Dextrose gel versus control, Outcome 2 Receipt of oral dextrose gel treatment for hypoglycaemia.
Figuras y tablas -
Analysis 1.2

Comparison 1 Dextrose gel versus control, Outcome 2 Receipt of oral dextrose gel treatment for hypoglycaemia.

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Comparison 1 Dextrose gel versus control, Outcome 3 Receipt of any medications for hypoglycaemia, such as glucagon or corticosteroids.
Figuras y tablas -
Analysis 1.3

Comparison 1 Dextrose gel versus control, Outcome 3 Receipt of any medications for hypoglycaemia, such as glucagon or corticosteroids.

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Comparison 1 Dextrose gel versus control, Outcome 4 Number of episodes of hypoglycaemia (glucose oxidase method) (total number per infant).
Figuras y tablas -
Analysis 1.4

Comparison 1 Dextrose gel versus control, Outcome 4 Number of episodes of hypoglycaemia (glucose oxidase method) (total number per infant).

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Comparison 1 Dextrose gel versus control, Outcome 5 Adverse events (e.g. choking or vomiting at time of administration).
Figuras y tablas -
Analysis 1.5

Comparison 1 Dextrose gel versus control, Outcome 5 Adverse events (e.g. choking or vomiting at time of administration).

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Comparison 1 Dextrose gel versus control, Outcome 6 Separation from mother for treatment of hypoglycaemia (admission to NICU for hypoglycaemia).
Figuras y tablas -
Analysis 1.6

Comparison 1 Dextrose gel versus control, Outcome 6 Separation from mother for treatment of hypoglycaemia (admission to NICU for hypoglycaemia).

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Comparison 1 Dextrose gel versus control, Outcome 7 Neonatal seizures.
Figuras y tablas -
Analysis 1.7

Comparison 1 Dextrose gel versus control, Outcome 7 Neonatal seizures.

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Comparison 1 Dextrose gel versus control, Outcome 8 Duration of initial hospital stay (days).
Figuras y tablas -
Analysis 1.8

Comparison 1 Dextrose gel versus control, Outcome 8 Duration of initial hospital stay (days).

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Comparison 1 Dextrose gel versus control, Outcome 9 Exclusive breastfeeding at discharge.
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Analysis 1.9

Comparison 1 Dextrose gel versus control, Outcome 9 Exclusive breastfeeding at discharge.

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Comparison 1 Dextrose gel versus control, Outcome 10 Breastfeeding (6 weeks).
Figuras y tablas -
Analysis 1.10

Comparison 1 Dextrose gel versus control, Outcome 10 Breastfeeding (6 weeks).

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Summary of findings for the main comparison. Dextrose gel compared with placebo for prevention of hypoglycaemia in newborn infants

Dextrose gel compared with placebo for prevention of hypoglycaemia in newborn infants

Patient or population: newborn infants at risk of neonatal hypoglycaemia
Setting: New Zealand
Intervention: dextrose gel
Comparison: placebo gel

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

No. of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with control

Risk with dextrose gel

Hypoglycaemia

543 per 1000

413 per 1000
(337 to 511)

RR 0.76
(0.62 to 0.94)

415
(1 RCT)

⊕⊕⊕⊕
HIGH

Major neurological disability at 2 years of age or older ‐ not reported

‐

‐

‐

‐

‐

No data were reported for this outcome

Receipt of treatment for hypoglycaemia during initial hospital stay ‐ not reported

‐

‐

‐

‐

‐

No data were reported for this outcome

Receipt of intravenous treatment for hypoglycaemia ‐ not reported

‐

‐

‐

‐

‐

No data were reported for this outcome

Adverse events (e.g. choking or vomiting at time of administration)

80 per 1000

87 per 1000
(44 to 173)

RR 1.09
(0.55 to 2.17)

413
(1 RCT)

⊕⊕⊕⊝
MODERATEa

Low event rates: 24/275 in dextrose gel group; 11/138 in placebo group

Separation from mother for treatment of hypoglycaemia (admission to NICU for hypoglycaemia)

87 per 1000

39 per 1000
(18 to 88)

RR 0.46
(0.21 to 1.01)

415
(1 RCT)

⊕⊕⊕⊝
MODERATEa

Low event rates: 11/277 in dextrose gel group; 12/138 in placebo group

Breastfeeding (exclusive at discharge)

674 per 1000

674 per 1000

(580 to 775)

RR 1.00

(0.86 to 1.15)

415
(1 RCT)

⊕⊕⊕⊝
MODERATEb

Breastfeeding (6 weeks postpartum)

535 per 1000

567 per 1000
(471 to 690)

RR 1.06
(0.88 to 1.29)

386
(1 RCT)

⊕⊕⊕⊝
MODERATEb

*The risk in the intervention group (and its 95% confidence interval) is based on assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI)

CI: confidence interval; OR: odds ratio; RR: risk ratio

GRADE Working Group grades of evidence
High quality: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

aEvidence of imprecision with wide confidence intervals, probably attributable to low event rates ‐ downgraded one level

bEvidence of imprecision. Evidence is based on a single trial, which, although robust, was not powered to detect differences in breastfeeding at discharge or six weeks postpartum ‐ downgraded one level

Figuras y tablas -
Summary of findings for the main comparison. Dextrose gel compared with placebo for prevention of hypoglycaemia in newborn infants
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Comparison 1. Dextrose gel versus control

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Hypoglycaemia Show forest plot

1

415

Risk Ratio (M‐H, Fixed, 95% CI)

0.76 [0.62, 0.94]

2 Receipt of oral dextrose gel treatment for hypoglycaemia Show forest plot

1

415

Risk Ratio (M‐H, Fixed, 95% CI)

0.79 [0.56, 1.12]

3 Receipt of any medications for hypoglycaemia, such as glucagon or corticosteroids Show forest plot

1

415

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4 Number of episodes of hypoglycaemia (glucose oxidase method) (total number per infant) Show forest plot

1

186

Mean Difference (IV, Fixed, 95% CI)

‐0.18 [‐0.55, 0.19]

5 Adverse events (e.g. choking or vomiting at time of administration) Show forest plot

1

413

Risk Ratio (M‐H, Fixed, 95% CI)

1.09 [0.55, 2.17]

6 Separation from mother for treatment of hypoglycaemia (admission to NICU for hypoglycaemia) Show forest plot

1

415

Risk Ratio (M‐H, Fixed, 95% CI)

0.46 [0.21, 1.01]

7 Neonatal seizures Show forest plot

1

415

Risk Ratio (M‐H, Fixed, 95% CI)

1.5 [0.06, 36.58]

8 Duration of initial hospital stay (days) Show forest plot

1

411

Mean Difference (IV, Fixed, 95% CI)

‐0.19 [‐0.66, 0.28]

9 Exclusive breastfeeding at discharge Show forest plot

1

415

Risk Ratio (M‐H, Fixed, 95% CI)

1.00 [0.86, 1.15]

10 Breastfeeding (6 weeks) Show forest plot

1

386

Risk Ratio (M‐H, Fixed, 95% CI)

1.06 [0.88, 1.29]
Figuras y tablas -
Comparison 1. Dextrose gel versus control
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