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Oral Glucose Gel for Neonatal Hypoglycemia: A Review of Clinical Effectiveness, Cost-Effectiveness and Guidelines

Last updated: July 4, 2018
Project Number: RC0998-000
Product Line: Rapid Response
Research Type: Drug
Report Type: Summary with Critical Appraisal
Result type: Report

Question

  1. What is the clinical effectiveness of oral glucose gel for healthy term or late preterm neonates?
  2. What is the cost-effectiveness of oral glucose gel for healthy term or late preterm neonates?
  3. What are the guidelines informing the use of oral glucose gel for healthy term or late preterm neonates?

Key Message

Limited evidence of high quality from one systematic review suggested that oral glucose gel administered in a hospital setting was clinically effective in preventing neonatal hypoglycemia in at-risk neonates. Evidence of moderate quality from two systematic reviews was inconclusive for oral glucose gel reducing the risk of separation of birthing parent and infant due to reporting of opposite effects. Limited evidence of low quality from four non-randomized studies was also inconclusive for oral glucose gel reducing admissions to neonatal intensive care or specialty care nurseries for treatment of hypoglycemia due to reporting of opposite effects. Limited evidence of moderate quality from two systematic reviews was inconclusive for oral glucose gel enhancing exclusive breastfeeding, as they reported opposite effects or lacked data. Evidence of moderate quality from one randomized controlled trial suggested that oral glucose gel improved quality of breastfeeding, although there is uncertainty regarding the assessment tool used. Low quality evidence on breastfeeding from four non-randomized studies is inconclusive as the studies reported opposite effects. Limited evidence of moderate quality from one systematic review and one non-randomized study suggested there was no difference in adverse events between oral glucose gel and placebo. Due to the low event rates and paucity of safety outcomes reported in other studies, we concluded there is insufficient evidence in our report to evaluate the safety of oral glucose gel.Limited evidence from one economic evaluation of moderate quality suggested that oral glucose gel is cost saving compared to standard care, despite wide variations in cesarean delivery rates, cost per dose of gel, cost per day spent in neonatal intensive care, and monitoring costs. Two-evidence based guidelines were identified; however, only one provided recommendations to inform the use of oral glucose gel. The overall body of evidence considered in our report was heavily weighted by one randomized controlled trial from New Zealand.