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Study flow diagram.
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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.
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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.
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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.
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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.
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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).
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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).
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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).
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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.
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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).
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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).
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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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