Review of evidences and relation with care provision
Neonatal hypoglycaemia is a clinical condition, and the characteristic feature is less than 30mg/dL of plasma glucose level in babies born within 24 hours (Harding et al., 2017). The condition is prevalent among newborn babies. It might result in metabolic problems and brain damage. The common issues are a delay in the development process, persistent seizure activity, personality disorders and others. In some instances, hypoglycaemia might result in impaired cardiovascular functions (Weston et al., 2016). The condition can be reversed in diabetic patients with the help of Dextrose gel.
Nevertheless, the implication of Dextrose gel on newborn babies should be considered as well. Two pieces of evidence have been considered, and the evidence shall be critically analysed and evaluated in this essay. The first evidence outlines that there is no adverse effect of Dextrose gel on neonatal babies. The second evidence shows the reasons behind considering the usage of Dextrose gel. Dextrose gel can handle hypoglycaemia among the term and pre-term babies that are suffering after 48 hours. A critical appraisal tool is used to identify threats after understanding the research findings. It is an opportunity for experts to make the right and informed decisions. It forms a vital part of evidence-based practice. The overall quality of the evidence increases. In this case, a CASP checklist consisting of 11 questions has been used so that a sense can be made of a Randomized Controlled Trial. It serves as a pedagogic tool and therefore lacks a scoring system. The tool can be useful for healthcare practitioners.
Review of evidences and relation with care provision
The first piece of evidence suggests that there is negligible adverse effect of Dextrose gel on newborn babies. The famous Sugar Babies study has been conducted using a “double-blind, randomised placebo-controlled trial.” The authors in the study considered the Dextrose gel cure for managing neonatal hypoglycaemia (Harris et al., 2013). The method mentioned before has been undertaken at a healthcare centre located in New Zealand. The selected sample for the study was newborn babies (35-42 weeks). The babies were at a severe threat of hypoglycaemia. The study is valid because it has been conducted under controlled supervision. Specific criteria such as the age of babies, critical appraisal tool, and maternal conditions have been considered. The group has been selected after receiving the advice from clinicians. Consultation with family members has been done as well. For trial purposes only, 40% of placebo or dextrose gel (200kg/mg) has been used. It is a credible study because a registered trial has been conducted under the Australian New Zealand Clinical Trials Registry. However, the initial outcomes resulted in the failure of treatment. 514 newborn babies were enrolled, and out of those, five babies were randomised inaccurately during the trial. The outcome of the trial was not harmful. Babies were treated with placebo gel and Dextrose gel.
In comparison to placebo gel, Dextrose gel was more effective because the occurrences of treatment failure reduced considerably. Again, undesirable effects were not noticed in newborn babies. The results of the study highlights that Dextrose gel can be widely used. It is less expensive. Healthcare practitioners can easily administer the application of Dextrose gel. Hence, it can be considered for reversing hypoglycaemia among newborn babies. The author’s aim has been fulfilled, and the evidence provided clearly supports the study. The study is significant because healthcare centres can now use Dextrose gel for babies under threat of hypoglycaemia. It increased the scope of the study. It can be a good example of evidence-based practice. Further research can be conducted, as well. The question that the study aimed to answer is relevant and useful for the medical community.
The second evidence shows that Dextrose gel can be securely used in case of initial treatment. Neonatal hypoglycaemia can be managed in pre-term and term-babies. The second study has been conducted to understand the outcomes of the previous, Sugar Babies Study. The researchers conducted a follow-up session for two years for the remaining 184 children (Harris et al., 2016). The specific study design has been used, and a few parameters have been considered. These are motor skill development, behaviour and language development after two years of the Dextrose or Placebo gel treatment on babies. The study is significant because it highlights that Dextrose gel can be a useful healing for neonatal hypoglycaemia. However, an additional point has been suggested. Neurosensory impairment became a prevalent issue among those children.
Both studies provide similar pieces of evidence, and it can be stated that Dextrose gel treatment can be useful because it is cost-effective and straightforward. Hence, it has a significant impact on care provision. It is essential to note that there is no adverse effect of Dextrose gel on babies. However, even after two years, the follow-up study suggested that neural impairment is common and cerebral palsy or mental retardation is common as well.
The healthcare practitioners can utilise the outcomes of the study as it provides supporting evidence. The follow-up study of two years is a reassurance. The outcomes of both the initial and follow-up studies are unbiased. People who are beginning to reflect on the usage of Dextrose gel can be reassured now as neonatal hypoglycaemia can be managed with this gel. The usage of the randomised trial has proven effective. Since there are no additional risks of using Dextrose gel; it can be employed in health centres. The learning points from both the evidence are the efficacy of Dextrose gel. Again, the admission rate for neonatal ICU in case of hypoglycaemia has reduced as well. Earlier babies used to be fed with formula within 2 weeks of birth. Now, the practice can be reduced.
The success of the initial study can be realised because the babies that participated in the initial research were seen again after two years. The Sugar Babies trial became a renowned phenomenon because it reassured mothers that they could breastfeed their babies without having to admit them in Special Care Baby units (Auckland.ac.nz, 2019). New changes can be advocated now. The blood glucose concentration of babies after treatment has improved. Babies respond to Dextrose gel positively, and the need for formula milk has been reduced (Ter et al., 2017). The Dextrose solution is an alternative glucose source and hypoglycaemia can be effectively managed.
Auckland.ac.nz. 2019. Sugar Babies - The University of Auckland. [online] Available at: https://www.auckland.ac.nz/en/liggins/our-research/research-themes/healthy-mothers-healthy-babies/clinical-trials/complete-clinical-studies/sugar-babies.html [Accessed 8 Dec. 2019].
Harding, J.E., Harris, D.L., Hegarty, J.E., Alsweiler, J.M. and McKinlay, C.J., 2017. An emerging evidence base for the management of neonatal hypoglycaemia. Early human development, 104, pp.51-56. https://www.sciencedirect.com/science/article/abs/pii/S0378378216305783
Harris, D.L., Alsweiler, J.M., Ansell, J.M., Gamble, G.D., Thompson, B., Wouldes, T.A., Yu, T.Y., Harding, J.E., Ansell, J., Bevan, C. and Brosnanhan, J., 2016. Outcome at 2 years after dextrose gel treatment for neonatal hypoglycemia: follow-up of a randomised trial. The Journal of pediatrics, 170, pp.54-59. https://www.sciencedirect.com/science/article/abs/pii/S0022347615013050
Harris, D.L., Weston, P.J., Signal, M., Chase, J.G. and Harding, J.E., 2013. Dextrose gel for neonatal hypoglycaemia (the Sugar Babies Study): a randomised, double-blind, placebo-controlled trial. The Lancet, 382(9910), pp.2077-2083. https://www.sciencedirect.com/science/article/pii/S0140673613616451
Ter, M., Halibullah, I., Leung, L. and Jacobs, S., 2017. Implementation of dextrose gel in the management of neonatal hypoglycaemia. Journal of paediatrics and child health, 53(4), pp.408-411. https://onlinelibrary.wiley.com/doi/abs/10.1111/jpc.13409
Weston, P.J., Harris, D.L., Battin, M., Brown, J., Hegarty, J.E. and Harding, J.E., 2016. Oral dextrose gel for the treatment of hypoglycaemia in newborn infants. Cochrane Database of Systematic Reviews, (5). https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD011027.pub2/abstract