Delivery room glucose to reduce the risk of admission hypoglycemia in preterm infants: a systematic literature review

Figures & data

Figure 1. Prisma diagram of literature search.

Table 1. Summary of data from included studies.

Author	Study design	Exposure definition	Admission hypoglycemia threshold (mg/dL)	Proportion with outcome (exposed)	Proportion with outcome (nonexposed)	Proportion with exposure (cases)	Proportion with exposure (controls)	Reported measure	Method of adjustment	Confounding factors
Carr et al. [27]	Quasi-experimental, before-after study	Prophylactic 40% dextrose gel (oral/buccal) given prospectively to all infants during the QI cycles.	<36	41/150 (27%)	57/150 (38%)	n/a	n/a	Reduction in hypoglycemia (38% in nonexposed to 27% in exposed; p < 0.05)	Nil	Retrospective comparison group
Castrodale and Rinehart [28]	Quasi-experimental, before-after study	As part of adoption of Golden Hour protocol, PIV or UVC inserted and dextrose 10% started within 1 h of birth and prior to admission to NICU	≤50	33/119 (27%)	47/106 (44%)	n/a	n/a	Admission BG >50 mg/dL favoring exposure p < 0.012	Nil	Retrospective comparison group. Golden hour temperature control protocol, admission temperature within range favoring exposure p < 0.002
Croop et al. [29]	Quasi-experimental, before-after study	As part of adoption of Golden Hour protocol, a PIV line was inserted either in the Delivery Room or immediately upon arrival to NICU and prior to definitive UVC insertion	≤45	7/134 (5%)	14/80 (17%)	n/a	n/a	Less admission hypoglycemia favoring exposure p < 0.012	Nil	Retrospective comparison group. Golden hour thermoregulation protocol, Golden hour early antibiotics (via PIV), Golden hour respiratory management. Less temperature outside euthermic range favoring exposure p < 0.001
De Carolis et al. [30]	Observational, retrospective cohort	UVC inserted in delivery room, dextrose 10% started immediately	≤29	8/40 (20%)	38/97 (39%)	n/a	n/a	Univariate analysis of admission hypoglycemia favoring exposure p < 0.03. Multivariate analysis weakly associated with early UVC positioning (p = 0.07)	Multivariate logistic regression analysis	See Supplementary Materials
Yuan et al. [31]	Case-control study	Peripheral IV insertion and glucose infusion commenced before admission to NICU (and before admission blood glucose)	≤40	n/a	n/a	23/86 (27%)	87/172 (50%)	Multivariate regression analysis showed that intravenous glucose use before admission (OR = 0.318, 95%CI: 0.171–0.591, p < 0.001) was a protective factor against hypoglycemia in preterm infants	Multivariate logistic regression analysis	See Supplementary Materials

Figure 2. Odds ratios of hypoglycemia at NICU admission (exposure = delivery room parenteral glucose).

Figure 3. Summary of risk of bias.

Harris DL, Weston PJ, Signal M, et al. Dextrose gel for neonatal hypoglycaemia (the sugar babies study): a randomised, double-blind, placebo-controlled trial. Lancet. 2013;382(9910):2077–2083.

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Gupta K, Amboiram P, Balakrishnan U, et al. Dextrose gel for neonates at risk with asymptomatic hypoglycemia: a randomized clinical trial. Pediatrics. 2022;149:e2021050733.

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Meneghin F, Manzalini M, Acunzo M, et al. Management of asymptomatic hypoglycemia with 40% oral dextrose gel in near term at-risk infants to reduce intensive care need and promote breastfeeding. Ital J Pediatr. 2021;47(1):201.

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Makker K, Alissa R, Dudek C, et al. Glucose gel in infants at risk for transitional neonatal hypoglycemia. Am J Perinatol. 2018;35(11):1050–1056.

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Harding JE, Hegarty JE, Crowther CA, et al. Evaluation of oral dextrose gel for prevention of neonatal hypoglycemia (hPOD): a multicenter, double-blind randomized controlled trial. PLoS Med. 2021;18(1):e1003411.

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