Unlike most medical students, Amr Matoq, MD, Chief Resident in the Department of Pediatrics at the University of Florida College of Medicine-Jacksonville, says that breastfeeding has been a big part of his education.
Recently, Dr. Matoq was involved with a quality improvement project, Improving In – Hospital Exclusive Breastfeeding Rates (PC-05): The Effect of Delayed Newborn Bath and Oral Dextrose Gel for Hypoglycemia on PC-05. Their in-hospital exclusive breastfeeding rate increased from 20.6 percent to 32.6 percent over 19 months using two simple and cost-effective interventions.
Dr. Matoq and his team concluded that adopting dextrose oral gel as the first line of treatment for neonatal hypoglycemia (low blood sugar) and delaying the newborn bath both increase EBF rates in check with the Joint Commission’s perinatal care core measures.
Out with the old, in with the new
Traditionally, hospitals correct low blood sugar with formula feeds and intravenous glucose/dextrose.
There are several risk factors for developing hypoglycemia including prematurity and babies born to diabetic mothers. Prolonged hypoglycemia can cause seizures and serious brain injury.
Dr. Matoq says that because the health implications can be serious, babies may end up receiving formula because providers aren’t always confident the situation will improve without it.
But there are dangers associated with formula supplementation. The dangers of not breastfeeding are well known too. Further, intravenous glucose administration interrupts bonding time between new families.
Administering dextrose oral gel though allows for a rapid rise in blood sugar without interfering with breastfeeding.
Simple, painless, cost-effective?
Dr. Matoq says that there is no new science behind the gel; it’s simply applied to a different age group which should help its use to be easily adopted into practice. No evidence suggests adverse effects to the infant either.
Dextrose oral gel is affordable. In fact, one study showed that its application came out to about 2 dollars per child.
Another study points out that dextrose oral gel is painless and that the intervention “requires no special expertise or equipment and hence is applicable in almost any birth setting.”
However, Carmela Baeza, MD, IBCLC expresses her concerns regarding dextrose oral gel in a comment to this blog post:
I fear posts such as this one…
The way you present oral dextrose gel makes it seem perfectly safe and totally innocuous. However, it means:
1. someone (you actually say “requires no expertise” – implying that anyone can just stick finger in baby´s mouth) puts their finger in newborn baby´s mouth – not good for oral stimulation
2. a substance that is not colostrum is in baby´s mouth – not good for oral microbiome
3. Mother does not receive breast stimulation, which is sooo necessary in the first few hours after birth to establish a good supply.
4. Message to mother is: your colostrum does not do it.It is very very rare for mother´s colostrum to not be available. So why not give it to babies?
We´ve started a program in which, if baby has not latched and breastfed (because he cannot or because he is separated from mom) in the first hour – two hours after birth, per protocol someone teaches mother to extract colostrum and the baby gets fed. We are getting colostrum volumes ranging from 15 to 45 ml in that first hand expression. And double bonus: babies with ok glycemia and very empowered moms.
Dr. Matoq confirms that breastfeeding is the most suitable nutrition for babies, but he says he’s most fascinated by the emotional connection that breastfeeding provides for mom and baby.
Expansion of donor human milk program
This year, UF Health Jacksonville expanded its donor human milk program to hypoglycemic infants. Infants who receive human milk spend less time in the hospital and more time bonding with their families.
Not only are mothers happy about the use of donor human milk, Dr. Matoq points out that the staff is “really enthusiastic about it too.”
Dr. Matoq and his team presented their findings from Improving In-Hospital Breastfeeding Rates (PC-05): The Effect of Delayed Newborn Bath and Oral Dextrose Gel for Hypoglycemia on PC-05 at The Academy of Breastfeeding Medicine’s 21st International Meeting in October.
In January, Dr. Matoq will join Healthy Children Project for the 23rd International Breastfeeding Conference in Orlando, Fla. where he will present and discuss his findings.
To register for the conference, please click here!
* Edited 12/5/16 from original version to include Dr. Baeza’s comment.
Hi!
I am a medical doctor and lactation consultant from Madrid.
I fear posts such as this one…
The way you present oral dextrose gel makes it seem perfectly safe and totally inocous. However, it means:
1. someone (you actually say “requires no expertise” – implying that anyone can just stick finger in baby´s mouth) puts their finger in newborn baby´s mouth – not good for oral stimulation
2. a substance that is not colostrum is in baby´s mouth – not good for oral microbiome
3. Mother does not receive breast stimulation, which is sooo necessary in the first few hours after birth to stablish a good supply.
4. Message to mother is: your colostrum does not do it.
It is very very rare for mother´s colostrum to not be available. So why not give it to babies?
We´ve started a program in which, if baby has not latched and breastfed (because he cannot or because he is separated from mom) in the first hour – two hours after birth, per protocol someone teaches mother to extract colsotrum and the baby gets fed. We are getting colostrum volumes ranging from 15 to 45 ml in that first hand expression. And double bonus: babies with ok glycemia and very empowered moms.
Hope that helps.
Carmela Baeza, MD, IBCLC
Hi Dr. Baeza,
That’s wonderful, thank you so much for sharing. May I integrate your comment into this post?
Dr. Meaza,
I am Rana Alissa, MD at UF Health Jacksonville, FL. I am the attending where the oral Dextrose Gel is used.
I just wanted to reply to your comment on this very important publication:
1) The “no special expertise” mentioned in the article means that you don’t have to go to a special course or get a special license to give the oral dextrose gel. Nurses and physicians are the personnel administering the gel to our babies ( I believe we both had enough schooling to administer oral gel) and I promise you that none of them stick their fingers in the baby’s mouth. It is administered via a syringe with gentle messaging to the cheeks from the outside.
2) We respect the baby’s microbiome very much here at USA. That is why this Dextrose gel is FDA (Food and Drug Administration) approved.
3) I don’t think you understood how and when we administer the oral Dextrose gel.
Here is how: when baby has hypoglycemia ( we use the neonatal hypoglycemia protocol per AAP: American Academy of Pediatrics with specific values and timing for blood glucose checks when needed) we administer oral dextrose gel to the baby and we place the baby, immediately after, on mom’s breast for breastfeeding (breast stimulation is preserved). Actually, that is the main purpose of the dextrose gel: to keep mom and baby together and continue to breastfeed despite the few hypoglycemia episodes the baby is having.
4) We have a great supporting team in our hospital. This team explains to mom every step, why and how her baby is having hypoglycemia. So, we are educating the new mom that her baby needs some more help since he/she are at risk for hypoglycemia and together we can help. We are guiding her with each step and each breastfeeding. Hence our breastfeeding rate is in the rise.
So because of the success of the oral Dextrose Gel, we are decreasing the separation of mom and baby and there is no need to express colostrum since the baby is directly breastfeeding.
Finally, at our hospital since we care a lot about breastfeeding, if for any reason the baby has to be separated from mom, we give him/her donor breast milk plus mom’s own colostrum to feed the baby. That is actually a triple bonus: Baby with normal “not only ok” glucose, empowered moms and great staff & administration.
Please let me know if you have any questions.
Thank you!
RA
Thank you for your time and consideration.
Forgive me if the tone of my post was not corteous, sometimes writing in a languege other than one´s first is a bit challenging.
My fear with interventions of any type is that we begin them because they are apparently harmless, and then when they are ultimately proven not harmless, there is no going back. Interventions like the one you propose are easy and so everyone likes to implement them – it´s much easier than supporting a mother and expressing colsotrum.
About the baby´s oral microbiome, the important issue is not wether it´s FDA approved (which of course it must be) but that you are filling the baby´s mouth with a dextrose gel, which will objectively alter the microbiome (since you are putting something in the mouth that is not what naturally should be there, and which will possibly feed diferent bacteria than the ones that colsotrum feeds), or at least you must suppose that it does until you prove the contrary.
About the when and how you administer it, you say “when baby has hypoglycemia (per AAP protocol) we administer oral dextrose gel to the baby and we place the baby, immediately after, on mom’s breast for breastfeeding (breast stimulation is preserved)”. Have you tried giving the bay colsotrum FIRST, before you give the gel? Is there a trial that compares both interventios, that shows that hyploglycemia resolves with oral gel but NOT with expressed colostrum? (I am supposing baby is having difficulties feeding on its own).
Until the gel is proven to be BETTER than expressed colostrum, I do not think it shoud be advocated for as a correct intervention in units that support breastfeeding (or anywhere, for that matter).