Newnam Katherine M, Bunch Marissa
University of Tennessee Knoxville, College of Nursing, Knoxville (Dr Newnam); Children's Hospital of the King's Daughters, Norfolk, Virginia (Dr Newnam); and The University of Tennessee Chattanooga, School of Nursing, Chattanooga (Ms Bunch).
Adv Neonatal Care. 2017 Dec;17(6):470-477. doi: 10.1097/ANC.0000000000000426.
Transient asymptomatic neonatal hypoglycemia (TANH) is common as infants transition from their mother's energy stores to their own. There is little evidence supporting the blood glucose threshold that indicates a need for treatment although sustained hypoglycemia has been correlated with negative neurodevelopmental consequences. Treatment of TANH includes a stepwise approach from supplemental enteral feedings, buccal glucose gel, intravenous dextrose infusion, and/or transfer to special care units including neonatal intensive care units.
The purpose of this evidence-based practice brief is to review current evidence on 40% buccal glucose gel administration as a treatment strategy for TANH.
METHODS/SEARCH STRATEGY: CINAHL, Cochrane, Google Scholar, and PubMed were searched using the key words and restricted to English language over the last 7 years.
FINDINGS/RESULTS: The use of buccal dextrose gel for TANH may reduce neonatal intensive care unit admissions, reduce hospital length of stay and cost, support the mother-infant dyad through reduced separation, support exclusive breastfeeding, and improve parental satisfaction without adverse neurodevelopmental consequences.
Timely collection of blood glucose levels following intervention is critical to support clinical decisions. Clinicians should offer family education regarding the rationale for serial glucose monitoring and treatment indications including buccal glucose administration. Clinical protocols can be revised to include use of buccal dextrose gel.
There is a need for rigorous long-term studies comparing treatment thresholds and neurodevelopmental outcomes among various treatment strategies for TANH.
短暂无症状新生儿低血糖（TANH）在婴儿从母亲的能量储备过渡到自身能量储备时很常见。尽管持续性低血糖与负面神经发育后果相关，但几乎没有证据支持表明需要治疗的血糖阈值。TANH的治疗包括逐步方法，从补充肠内喂养、口腔葡萄糖凝胶、静脉输注葡萄糖，和/或转至包括新生儿重症监护病房在内的特殊护理病房。
本循证实践简报的目的是回顾关于使用40%口腔葡萄糖凝胶作为TANH治疗策略的现有证据。
方法/检索策略：使用关键词在CINAHL、Cochrane、谷歌学术和PubMed中进行检索，并限制为过去7年的英文文献。
使用口腔葡萄糖凝胶治疗TANH可能会减少新生儿重症监护病房的收治、缩短住院时间并降低成本，通过减少母婴分离来支持母婴关系、支持纯母乳喂养，并提高家长满意度，且无不良神经发育后果。
干预后及时采集血糖水平对于支持临床决策至关重要。临床医生应向家属提供关于连续血糖监测的基本原理和治疗指征（包括口腔葡萄糖给药）的教育。临床方案可进行修订，以纳入口腔葡萄糖凝胶的使用。
需要进行严格的长期研究，比较TANH各种治疗策略的治疗阈值和神经发育结局。
