Efficacy of Oral Dextrose Gel for Neonatal Hypoglycaemia: An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials With 4368 Patients.

BACKGROUND: Neonatal hypoglycaemia is a common metabolic disorder affecting up to 15% of healthy neonates and a higher proportion of at-risk infants. Oral 40% dextrose gel has emerged as a promising, low-cost intervention, but recent evidence remains inconsistent. This updated meta-analysis evaluated the efficacy of 40% oral dextrose gel for preventing and treating neonatal hypoglycaemia. METHODS: We systematically searched PubMed, Embase, Web of Science, Scopus and the Cochrane Library from inception to March 2026 for randomized controlled trials evaluating 40% oral dextrose gel in neonates at risk for or with confirmed hypoglycaemia. The primary outcome was hypoglycaemia. We used R software (version 4.5.0) for the analysis. RESULTS: Eight RCTs comprising 4368 neonates were included. Dextrose gel did not significantly reduce hypoglycaemia, treatment success, recurrent hypoglycaemia, neonatal intensive care unit (NICU) admission, breastfeeding at discharge or formula feeding. Sensitivity analysis excluding Harding et al. (2021) for NICU admission yielded a statistically significant 24% reduction. Trim-and-fill adjustment for recurrent hypoglycaemia and formula feeding did not alter conclusions. CONCLUSIONS: Current evidence did not demonstrate a statistically significant reduction in overall hypoglycaemia, treatment failure, recurrent hypoglycaemia, NICU admission or breastfeeding interruption after administration of oral 40% dextrose compared with control. While safe and low-cost, current evidence does not support routine use as a standalone intervention. Heterogeneity across protocols and populations warrants standardization in future trials. TRIAL REGISTRATION: PROSPERO registration number: CRD420261368171.