Sugar gel could prevent potentially dangerous condition in newborns

07 November 2016
Amanda Kamani and her sons.
Amanda Kamani and her sons six-month-old Xavier (left) and three-year-old Tobias (right), who participated in the hPOD and pre-hPOD studies

Auckland mother Amanda Kamani was more than happy to participate in a study in which a dab of sugar gel was rubbed inside the mouths of both her sons an hour after birth because she knew it could help prevent thousands of babies from developing a common, potentially dangerous condition.

Kamani and her sons took part in a series of studies, known as hPOD, investigating whether a simple dab of inexpensive dextrose (sugar) gel, applied to at-risk newborns on their inside cheek an hour after birth could prevent them from getting neonatal hypoglycaemia.

The research led by a team from the Department of Paediatrics and the Liggins Institute at the University of Auckland is important becuase as many as a third of babies born in New Zealand are at risk of this condition, which involves a sustained dip in blood sugar levels following birth.

Left untreated, it can cause developmental brain damage and lowered education outcomes later in life. At-risk babies are those born smaller or larger than usual, preterm babies and babies whose mothers have any form of diabetes – this last a growing group, with the rising incidence of gestational (pregnancy-related) diabetes.

Low blood sugar often requires babies to go into an intensive or special care unit, separating mother and baby just as they are trying to establish breastfeeding in the critical first days after birth. Currently, there is no established preventative, and many at-risk newborns are given formula, which can also disrupt breastfeeding.

Kamani is a nurse who has worked in a neonatal intensive care unit (NICU), and has type 1 diabetes. When she heard about the studies she leapt at the chance to participate.

“I was really keen,” she says. “This is an amazing trial because if it works it'll be so good – if you can give all babies at risk this sugar gel, and then most of them don’t have low blood sugar and everything that goes with that.”

Her firstborn son, Tobias, now aged three, took part in the preliminary trial, dubbed “pre-hPOD”, designed to find the best dose of sugar gel to use, and a follow-up study at age two. Her second son, six-months-old Xavier, took part in a larger main “hPOD” trial, still underway, comparing dextrose gel with placebo in newborn babies at risk of neonatal hypoglycaemia.

Kamani liked that the trial didn’t interfere with bonding in those early hours. “The gel was rubbed in his mouth and he stayed with me - I could still hold him and cuddle him. Then they tested his blood sugars – a prick on his heel - which they would have done anyway because he was at risk for low blood sugars.”

Findings from the pre-hPOD trial are published today in high-ranking journal PLOS Medicine.

Newborns in the trial were either given a single dose at one hour after birth, or that first dose plus three others within the first 12 hours. Researchers also tested smaller and larger first doses. A single smaller dose was the most effective and best-tolerated by babies and parents.

The pre-hPOD study also showed for the first time that dextrose gel given an hour after birth can lower newborns’ risk of developing low blood sugar. Of 277 babies who received any dose of dextrose, 41 percent developed hypoglycaemia in the first 48 hours of life, compared with 52 percent of 138 babies who received placebo gel. No babies developed high blood sugar, and breastfeeding rates were similar across all groups.

“We’re very excited about these results,” says researcher Dr Jane Alsweiler, a senior lecturer at the University of Auckland Medical School and paediatrician at Auckland Hospital. “Using dextrose gel to prevent low blood sugars has the potential to stop babies being separated from their mothers in hospital and to improve their long-term development, without any disruption of breast feeding.

“There was also a trend towards fewer babies needing to go to NICU for hypoglycaemia,” she says. “The main hPOD trial will have enough babies to show this outcome more conclusively.”

Distinguished Professor Jane Harding from the Liggins Institute, a preeminent New Zealand paediatrician who is leading the research team behind pre-hPOD and hPOD, also led research that pioneered the use of the same dextrose gel as a treatment for newborns with neonatal hypoglycaemia – now a routine treatment in many New Zealand hospitals and in a growing number of hospitals overseas.

“We thought if it works well to treat babies with low blood sugar, could we use it to prevent babies getting low blood sugars?,” says Professor Harding. “If we could do that, we might reduce the number of blood tests they need, reduce the amount of angst that families experience, and potentially even prevent brain damage.”

Kamani encourages pregnant women to consider taking part in the trial, which is being run at eight hospitals – seven in the North Island, and Southland Hospital.

“It’s got the potential to make such a huge difference for so many babies and their families,” she says. “Even though it might sound scary – ‘we're experimenting on you’ - it's only a little bit of gel, all the blood sugar testing they would do anyway. And you still get to be the mum and do all the mum things first.”

The pre-hPOD trial received funding from Cure Kids and the Auckland Medical Research Foundation.  You can read the full article here:  Prophylatic Oral Dextrose for Newborn Babies at Risk of Neonatal Hypoglycaemia: A Randomised Controlled Dose-finding Trial (the Pre-hPOD Study)