Prophylactic Dextrose Gel and School-Age Neurocognitive Outcomes

Key Takeaways

• School-age neurocognitive impairment was similar in children assigned to dextrose gel and placebo.
• Exploratory analyses found more emotional-behavioral difficulty and lower psychosocial function in the dextrose gel group.
• The investigators concluded that current evidence does not support routine prophylactic use of dextrose gel for the prevention of neonatal transitional hypoglycemia.

At early school age, children in the hPOD follow-up who received prophylactic buccal dextrose gel at 1 hour of age had neurocognitive outcomes similar to those of children given placebo, with neurocognitive impairment in 59% and 57%, respectively.

The school-age follow-up of the hPOD multicenter, double-blind, 2-arm, parallel, placebo-controlled trial included participants recruited at birth across 9 hospitals in New Zealand. Children were born at 35 weeks’ gestation or more and weighed 2.2 kg or more, with at least 1 risk factor for transitional neonatal hypoglycemia. Investigators compared a single 0.2-g/kg dose of buccal dextrose gel with placebo at 1 hour of age. Assessments were conducted primarily at the children’s schools, and data collection ran from April 2021 to July 2025. The prespecified primary outcome was neurocognitive impairment at 6 to 7 years.

Neurocognitive impairment was defined as a standard score more than 1 SD below the normative mean on 1 or more of 7 NIH Toolbox items. The adjusted risk difference for the primary outcome was 3%, with a 95% CI from -3% to 9% and P = .36. Follow-up included 532 of 652 eligible children in the dextrose gel group and 535 of 642 in the placebo group. The primary outcome was similar between groups.

Exploratory outcomes included emotional-behavioral difficulty, low physical or psychosocial functioning, overweight or obesity, and component measures of the primary outcome. Children assigned to dextrose gel were more likely to have emotional-behavioral difficulty, occurring in 24% versus 18%, with an adjusted risk difference of 7% and a 95% CI of 1% to 12%. Low psychosocial function was also more common, affecting 17% versus 12%, with an adjusted risk difference of 6% and a 95% CI of 1% to 10%.

Other exploratory outcomes were similar between groups, and the investigators concluded that the available evidence does not support routine prophylactic use of dextrose gel for the prevention of neonatal transitional hypoglycemia.