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The use of intramuscular glucagon to prevent IV glucose infusion in early neonatal hypoglycemia

Abstract

Objective

To investigate the success rate of intramuscular (IM) glucagon in preventing need for IV glucose and describe its glycemic effect.

Methods

Retrospective study of 158 consecutive term neonates with feeding-resistant hypoglycemia treated with glucagon.

Results

After glucagon, blood glucose (BG) increased in all but 1 infant by 25.9 ± 17.1, 42.1 ± 21.1, and 39.2 ± 28.3 mg/dL (1.4 ± 0.9, 2.3 ± 1.2, 2.2 ± 1.6 mmol/L) at 30, 60 and 120 mins respectively. In multivariable logistic regression, glucagon success was dependent upon gender (increased male risk) (P = 0.021), meeting American Academy of Pediatrics (AAP) criteria for immediate IV glucose (P = 0.004), birth weight, (P = 0.018) and delta glucose concentration at 60 min (P = 0.013). After IM glucagon, 24 out of 49 infants that met AAP criteria for immediate IV glucose (49%) ended up not requiring any additional intervention.

Conclusions

Glucagon increases BG nearly universally in hypoglycemic infants and allowed reducing the number of infants that needed immediate IV glucose infusion therapy by ≈half.

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Fig. 1: Study clinical protocol.
Fig. 2

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Authors

Contributions

Dr YK contributed to the concept and its realization, statistical analyses and writing of the paper. Ms OD contributed to the database collection and organization, and to the writing of the paper. Dr FBM contributed to the concept and its realization, statistical analyses and writing of the paper. Dr NW contributed to the concept and critical review of the paper. Drs CH contributed to statistical analyses and critical review of the paper. Drs ABN contributed to the realization of the project, troubleshooting of technical issues, and reviewed critically the paper. All authors reviewed the paper for important intellectual contents and approved the final version. All authors agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Yair Kasirer.

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The authors declare that they have no conflict of interest.

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Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Ophir Dotan’s participation in this study was performed in fulfillment of research requirements toward the MD degree.

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Kasirer, Y., Dotan, O., Mimouni, F.B. et al. The use of intramuscular glucagon to prevent IV glucose infusion in early neonatal hypoglycemia. J Perinatol 41, 1158–1165 (2021). https://doi.org/10.1038/s41372-021-00925-x

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