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O-007 Neonatal Hypoglycemia: Intensive Treatment Or Expectant Monitoring?
  1. AAMW van Kempen1,
  2. PF Eskes2,
  3. JH Kok3,
  4. N Boluyt4
  1. 1Neonatology, OLVG Hospital, Amsterdam, Netherlands
  2. 2Pediatrics, Meander Medical Center, Amersfoort, Netherlands
  3. 3Neonatology, Emma Children’s Hospital/AMC, Amsterdam, Netherlands
  4. 4NA, National Health Care Institute, Diemen, Netherlands

Abstract

Background The definition of neonatal hypoglycemia is still subject to discussion, resulting in a wide range of treatment protocols.

Objective To compare two expert-based management strategies at both ends of the current treatment-spectrum of ‘moderate’ neonatal hypoglycemia (plasma glucose 2.0–2.5 mmol/l).

Design/methods Otherwise healthy, ‘high-risk’ newborns ≥35 weeks and ≥2000 gram with moderate hypoglycemia: premature, small- or large-for-gestational-age or infants of diabetic mothers, were randomised to an intensive treatment strategy (aiming at [glucose] ≥2.6 mmol/l) or an expectant monitoring strategy (aiming at [glucose] ≥2.0 mmol/l). Development was assessed at 18 months (corrected) age, using the Bayley Scales of Infant Development (BSID-III). The study was designed as a non-inferiority trial.

Results In 84% of the 691 enrolled infants the BSID-III was performed. Cognitive and motor outcomes were comparable in both treatment arms (Table). The results were similar in the overall analysis and in the subgroups.

Abstract O-007 Table 1

Cognitive and motor outcomes at 18 months

The plasma glucose concentration was higher in the intensive treatment group: +0.24 mmol/l (+0.31;+0.16). Hypoglycemia episodes (after randomization) occurred more frequently in the expectant monitoring group (70% vs. 57%, p < 0.001). More infants in the intensive treatment group received additional feeding (94% vs. 76%), tube-feeding (12% vs. 4%) and/or intravenous glucose (20% vs. 6%) (all: p < 0.001).

Conclusion An expectant monitoring strategy is not inferior to intensive treatment with regard to developmental outcome at 18 months in otherwise healthy newborn infants ≥35 weeks and ≥2000 gram with moderate hypoglycemia.

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