Intramuscular Glucagon Effectiveness as a Treatment for Neonatal Hypoglycemia Compared to Intravenous Glucose Administration

Background: Early neonatal hypoglycemia (NH) might cause brain damage. Hence, prompt correction of blood glucose level (BGL) is mandatory. NH treatment depends on clinical signs of NH and BGL profile. Current treatment options of NH include oral human milk, oral glucose-fortified milk, I.M. glucagon (IMG) and I.V. bolus of 2mL/kg of glucose 10% (IVGB). We hypothesized that (IMG) for NH is as efficient as (IVGB).

Methods: We studied 236 neonates born after 35 weeks` gestation and had NH. Based on treatment type, infants were divided into 3 groups: (a) OGFM only, (b) OGFM+IMG and (c) OGFM+IVGB. We decided to study group (b) and group (c) only in order to do the comparison. These groups were compared regarding infants` characteristics and BGL profile. Three BGLs were recorded: BGL1: pre-treatment value, BGL2: 2-2.5 hour’s post-treatment and BGL3: a follow-up value (2-4 hours post-treatment). Two outcome measures were set: (1) both BGL2 and BGL3 ≥45mg/dL; (2) BGL3 ≥45mg & (BGL2 ≥45mg/dL or [delta BGL ≥50% & BGL2 ≥40mg/dL]). We used univariate analysis, multi-variate analysis and the “ENTER” tool in our research.

Results: We studied the first episode of NH occurring during the first day of life. The percentage of infants fulfilling the set outcome measures was significantly higher in the IMG group. Multi-variate stepwise analysis showed that compared to I.V. glucose treatment, glucagon was the only variable achieving significant and independent association with BGL2 ≥45mg/dL.

Conclusion: We conclude that IMG for treating NH is as effective as IVGB.