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.