Mini Oral Australasian Diabetes in Pregnancy Society Conference 2026

School-age outcomes after a randomised trial of dextrose gel to prevent neonatal hypoglycaemia (138792)

Christopher JD McKinlay 1 , Jane E Harding 2 , Jane M Alsweiler 1 , Gavin TL Brown 3 , Gregory D Gamble 2 , Alicia McNeill 2 , Jenny Rogers 2 , Benjamin Thompson 4 , Jason Turuwhenua 5 , Trecia A Wouldes 6
  1. Paediatrics: Child and Youth Health, University of Auckland, Auckland , AUCKLAND, New Zealand
  2. Liggins Institute, University of Auckland, Auckland , New Zealand
  3. Arts and Education, University of Auckland, Auckland , New Zealand
  4. School of Optometry and Vision Science, University of Waterloo, Ontario, Canada
  5. Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
  6. Psychological Medicine, University of Auckland, Auckland , New Zealand

Background: Effective, safe and baby-friendly interventions are needed to prevent transitional neonatal hypoglycemia, and subsequent neonatal unit admission and neurological sequelae. In the pre-hPOD Dosage Study (ACTRN12613000322730), prophylactic dextrose gel reduced the risk of hypoglycaemia and was associated with better motor and cognitive function at 2 and 6-7 years. However, in the larger multi-center hPOD Trial (ACTRN12614001263684), a single dose of dextrose gel did not decrease admissions, and at 2 years did not reduce neurocognitive impairment but was associated with worse developmental scores.

Objective: In the hPOD Trial, determine if prophylactic dextrose gel at 1 h of age improves neurocognitive function at 6-7 years, without adverse effects on health and wellbeing.

Design/methods: Double-blind, placebo controlled trial of 0.2g/kg buccal dextrose gel or placebo at 1 h of age among infants born at 35 weeks and at risk of transitional hypoglycaemia. At 6-7 years, children underwent a comprehensive developmental and health assessment. The primary outcome was neurocognitive impairment, defined as a standard score >1 SD below the normative mean on ≥1 of seven items from the NIH Toolbox.

Results: 532 of 652(82%) eligible children were assessed in the dextrose gel group and 535 of 642(83%) in the placebo group. 75% of children were exposed in utero to maternal diabetes. The proportion with neurocognitive impairment was similar between groups (dextrose gel 59% vs. placebo 57%, adjusted risk difference[aRD] -3%, 95%CI -3%,9%, p=0.36). Of 11 secondary outcomes, children who received dextrose gel vs. placebo were more likely to have emotional-behavioral difficulty on the Strengths and Difficulty Questionnaire (24% vs. 18%, aRD 7%, 95%CI 1%,12%) and low psychosocial function on the Child Health Questionnaire (17% vs. 12%, aRD 6%, 95%CI 1%,10%). Other secondary outcomes were similar between groups.

Conclusions: Administration of a single dose of dextrose gel in at-risk infants after birth to prevent transitional hypoglycaemia, compared to placebo, has little to no effect on the risk of neurocognitive impairment at early school-age, but could have adverse effects on psychological wellbeing. The current evidence does not support the routine use of dextrose gel for the prevention of neonatal transitional hypoglycaemia.