Sugar has been painted as a nutritional villain - but is now being dabbed on the inside of newborns' cheeks to prevent thousands of babies being admitted to intensive care.
The world-first research findings by New Zealand scientists at the Liggins Institute at the University of Auckland have meant babies with low blood sugar levels - which can cause developmental brain damage - are being treated with a dextrose gel rubbed inside their mouths.
The simple sugar gel, which costs little more than a dollar, is now being used in hospitals throughout New Zealand and around the world.
A new research trial of more than 2000 newborns (recruiting pregnant mums throughout the country) is taking that discovery a step further - treating "at risk" babies soon after birth. That's designed to see if that can prevent low blood sugar levels, reducing admissions to intensive care units, avoiding babies being separated from their mothers and interference with breastfeeding.
Up to 15 per cent of newborn babies in New Zealand are affected by low blood sugar (neonatal hypoglycaemia). Babies are most at risk if they are born prematurely, born too small or too large, or have mothers with diabetes.
Low blood sugar in the first week of life can affect a child's brain development long-term and educational outcomes.
Research led by Professor Jane Harding and her team at the Liggins Institute was first published in the international medical journal, The Lancet, in 2013. The "Sugar Babies" study was the first to show dextrose gel massaged inside a baby's cheek was more effective in treating hypoglycaemia than feeding alone.
In the past, babies with hypoglycaemia were often fed formula in the first few hours after birth; if that didn't work, they were admitted to intensive care and given glucose intravenously.
"At least 30 per cent of all babies are at risk of low blood sugar levels after birth and around half of them will have at least one episode. Ten per cent of those will be admitted to neonatal intensive care," Harding says.
"So we thought, why don't we give the gel soon after birth and see if we can prevent low blood sugar? It's an intervention that may have benefits in terms of a child's development, of keeping mums and babies together and supporting breast feeding."
The latest trial, known as hPOD, was preceded by a study looking at dosage and frequencies of administering the gel. The dosing trial, led by Dr Jo Hegarty and Dr Jane Alsweiler, showed a single dose after birth was effective.
Dr Chris McKinlay, a neonatologist and Liggins researcher involved in the on-going study, says neonatal hypoglycaemia is a common and major problem around the world: "What we're most excited about is the gel is inexpensive - a dollar or so - which means it can be used not only in main hospitals but any rural hospital or maternity unit and potential to be used in the developing world.
"There are not many therapies developing today that can be used equally in a low-income resource setting and a developed country."
A national guideline has been introduced so hospitals around New Zealand are now using the gel. There has also been "incredible interest" overseas, particularly in the United Kingdom, the United States and Australia. "Professor Harding gets frequent emails asking how to access the gel and how to use it."
The research has led to other collaborations within the University of Auckland. Studies have now begun looking at the long-term outcomes of children in the Sugar Babies trial to assess their brain development. Hypoglycaemia in babies can affect visual processing, motor-visual integration and the brain's executive functions - problem-solving and strategic decisions.
"To develop more advanced tests to evaluate children around the age of two, we've been collaborating with researchers in the Department of Psychological Medicine and the School of Optometry and Vision Science department. They may now look at more commercial applications for the tests they designed," McKinlay says.
The Director of the Liggins Institute, Professor Frank Bloomfield, says the hypoglycaemia research is one of a series of ground-breaking studies being undertaken at the Institute on at-risk and premature babies.
"Our fundamental focus is the nutrition and growth of babies and how it impacts on lifelong health. Previously, we really focused on getting these babies to survive, and now with technologies we are very good at that. We now have to work on how we get them to survive in a healthier way," he says.
"We're turning to questions on how best to nourish and grow these babies so they have the best possible outcomes growing up. It's a privilege to look after those babies."
*Families can find out more about joining the hPOD study on the Liggins Institute website.
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