Kiwi in­ge­nu­ity be­hind sweet spot in pre­vent­ing neu­ro­log­i­cal dam­age.

North & South - - Letters -

For gen­er­a­tions women have opted to let their new­born un­dergo a heel prick test, po­ten­tially not fully un­der­stand­ing the im­por­tance of iden­ti­fy­ing their child’s blood sugar level.

This sim­ple pro­ce­dure is the pre­cur­sor to a sim­i­larly sim­ple treat­ment that could ul­ti­mately pre­vent neu­ro­log­i­cal is­sues, be­fore their child is even two days old.

“Glu­cose, or sugar, is the pri­mary fuel for your brain. If we get a low blood sugar we will get a bit woozy, we know to eat some­thing. Ba­bies can­not com­mu­ni­cate that,” New Zealand’s first Neona­tal Nurse Prac­ti­tioner, Deb­o­rah Har­ris ex­plains.

“And there is a link between low blood sug­ars soon af­ter birth and poor neu­ro­log­i­cal out­come. Put sim­ply, brain dam­age.”

It was Har­ris’ Doc­toral th­e­sis that spurred a sim­ple yet trans­for­ma­tional way ba­bies around the world are treated: oral dex­trose gel. The gel treats low blood sugar – hy­po­gly­caemia – in a sim­i­lar way to people with di­a­betes, although it hadn’t been used on hy­po­gly­caemic ba­bies.

“About a third of all those ba­bies in New Zealand are born at risk of low blood sugar – ba­bies that are in­fants of di­a­betic moth­ers, or are small or large (ei­ther grown very well or not well at all while mum is preg­nant), or are late pre-term [born af­ter 35 weeks and be­fore 40 weeks],” Har­ris says.

Ba­bies with low blood sug­ars are nor­mally treated with feed­ing. If that doesn’t im­prove blood sug­ars, ad­mis­sion to the new­born in­ten­sive care unit (NICU) is usu­ally re­quired, for treat­ment with in­tra­venous dex­trose, with a drip placed in the new­born’s hand.

“Most of these ba­bies are oth­er­wise healthy and it’s hard for a mother and baby to be separated so soon af­ter birth.

“Our Sugar Ba­bies Study re­search found ba­bies with low blood sug­ars who were treated with dex­trose gel showed im­proved blood sugar lev­els, were less likely to be ad­mit­ted to the NICU for treat­ment and more likely to con­tinue to be breast-fed,” Har­ris says. “And with oral dex­trose gel, you treat the baby at the bed­side.”

Safe, tol­er­ated and in­ex­pen­sive, 40% dex­trose gel costs ap­prox­i­mately $2 per baby, the gel is mas­saged into the inside of a baby’s cheek, and ab­sorbed al­most im­me­di­ately. In the ma­jor­ity of ba­bies one dose reg­u­lates their blood sugar lev­els while they are learn­ing to get fuel from their milk.

Har­ris is “hum­bled” that her work has been so trans­for­ma­tional, and says the hard­est part of her job is find­ing re­search fund­ing.

Su­per­vised, and chal­lenged by the “re­ally clever” Dis­tin­guished Pro­fes­sor Dr Jane Hard­ing at Auck­land Univer­sity, Har­ris’ work was funded in part by two of New Zealand’s eight Med­i­cal Re­search Foun­da­tions – the Auck­land Med­i­cal Re­search Foun­da­tion and Waikato Med­i­cal Re­search Foun­da­tion.

“I couldn’t have done the Sugar Ba­bies study without the re­search foun­da­tions. The level of in­vest­ment re­quired can be sig­nif­i­cant. It gave me such a boost and al­lowed me to de­velop a treat­ment that is po­ten­tially life-chang­ing.

“I feel like the lit­tle red en­gine, ‘I think I can, I think I can, oh I can’. Re­search is so im­por­tant and fun­da­men­tal to find­ing bet­ter ways to care for our people. Oth­er­wise we keep do­ing the same things over and over and don’t ad­vance our knowl­edge.

“I would love to have the money to try to find a bet­ter way to test blood glu­cose con­cen­tra­tions. The heel prick test is rea­son­ably dif­fi­cult to do well, and can cause dis­tress for both the baby and par­ents.

“We can put men on the moon, we can do all sorts of very clever things but we can­not mea­sure blood glu­cose lev­els eas­ily in ba­bies.”

Deb­o­rah Har­ris.

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