Dextrose boluses versus burette dextrose infusions in prevention of hypoglycemia among preterms admitted at Mulago Hospital: An open label randomized clinical trial

Abstract

Background: Hypoglycemia is the most common metabolic problem in neonates its incidence is high in preterms. Use of continuous infusions of 10% dextrose which is best administered by automated infusion pumps to prevent hypoglycemia, is not readily available in many resource limited settings. Infusion by burettes may be more feasible than the current practice of using two hourly boluses of 10% dextrose in the Special Care Unit (SCU) at Mulago Hospital. Moreover, the efficacy of two hourly dextrose boluses in prevention of hypoglycemia among preterms is unknown. Objective: This study aimed at determining the efficacy of two hourly 10% dextrose boluses versus 10% dextrose infusion by burettes in prevention of hypoglycemia. It also aimed at describing survival among preterms admitted to SCU at Mulago Hospital in first 72 hours of admission. Methods: This was an open label RCT. Preterm neonates were randomized to receive 10% dextrose by either two hourly boluses or infusion by burettes. A glucometer was used to test capillary blood glucose. Hypoglycemia was defined as blood glucose less than 2.6mmol/l. Incidence proportions of hypoglycemia as well as the relative risk were determined. Efficacy of the 10% dextrose infusion by burettes was calculated from the expression; 1-RR. The proportion of preterms surviving at the end of 72 hours of follow up was described. Results: Between February and April 2012, one hundred and forty (140) preterms admitted at Mulago hospital were randomized to receive 10% dextrose by either two hourly boluses (68/140) or continuous infusion (72/140) by burettes. The mean gestational age was 31.3 (SD=2.5weeks), mean age (hours) 2.5 (SD=2.6 hours), mean random blood sugar at enrolment was 4.0 mmol/l (SD=1.4 mmol/l). The incidence of hypoglycaemia in the infusion arm was 11.1% versus 58.8% in the bolus arm (RR= 0.19, 95% CI; 0.09-0.37). Infusion of infusion was 81% compared to boluses (efficacy; 0.81, 95% CI; 0.63-0.90). Overall survival was 97.1% and there was no significant difference in the two study groups. Twenty nine of fifty nine (49%) had hyperglycaemia in the bolus arm versus 30/59 (50%) in the infusion arm. Conclusion: Continuous 10% dextrose infusion by burettes reduced the risk of developing hypoglycaemia by 81% compared to two hourly 10% dextrose boluses among preterms. Recommendations: continuous 10% dextrose infusion by burettes is recommended to prevent hypoglycaemia among preterms in SCU- Mulago hospital.