Acceptability and feasibility Oxygen therapy delivery methods
11. Evidence for Recommendations for Treatment of Hypoglycaemia
11.1 Sublingual administration of sugar in treatment of hypoglycaemia
Sublingual sugar may be used as an immediate irst aid measure in managing hypoglycaemia in children in situations where intravenous administration of glucose may be impossible or delayed. Strong recommendation, low quality evidence his recommendation places value on ease of use, low cost, and high availability in the absence of any serious risk, although the evidence is of low quality.11.1.1 Evidence and summary of findings
he panel identiied two randomized controlled trials RCTs from Burkina Faso and Mali, cited in a recent review of the management of hypoglycaemia [Achoki, 2010]. Barennes et al 2005 conducted an open-label, quazi-randomized trial of intravenous glucose, sublingual sugar, and oral sugar in Burkina Faso. Children aged 6 months to 15 years presenting to the outpatient department were eligible if: 1 they had symptoms and signs of either acute respiratory infection excluding pneumonia or malaria; 2 the caregiver agreed to attend an appointment the next morning; and 3 they had a blood glucose level between 3.3 to 5 mmoll. he study screened 156 children; 87 were excluded, including 19 children initially assigned to the sublingual group, who swallowed the sugar within the irst 10 minutes. Sixty-nine were randomized to one of ive groups: 1 half a tablespoon of water n = 11; 2 IV glucose 8 mL of 30 dextrose administered in a single bolus; 3 oral glucose 2.5 g sugar; 4 single dose sublingual group 2.5 g of wet sugar under the tongue; or 5 double dose sublingual group. he main outcome was treatment failure: the proportion of children who did not reach blood glucose 5.6 during the study period. Baseline characteristics were similar across groups. here were no treatment failures in the sublingual or intravenous groups, compared with 8 53 and 9 81.8 in the oral and water groups respectively p 0.05. he approximate bioavailability was 84 for sublingual administration. he mean SD time to reach a blood glucose 5.6 was 28.5 10.6 minutes and 25.7 9.5 for the sublingual and intravenous groups, respectively. Graz et al 2008 was an open-RCT of intravenous versus sublingual sugar in children with severe malaria and hypoglycaemia in Mali. Children were eligible ifParts
» Hospital Care WHO evidence 0
» Objectives of the recommendations
» Management of conflict of interest
» Defining the scope Methodology and process
» Evidence retrieval and synthesis process
» Consensus building and external peer review
» Review and update of the recommendations
» Proposed subsidiary products Implementation of the recommendations
» Implementation of the recommendations
» National adaptation and implementation
» Management of neonatal jaundice Empirical antibiotics for suspected neonatal sepsis
» Antibiotic treatment for non-severe pneumonia with no wheeze
» Inhaled salbutamol for treatment of acute wheezeasthma and
» Antibiotics for treatment of acute otitis media
» Clinical signs for detection of hypoxaemia in children
» Oxygen delivery methods Criteria for starting and stopping oxygen therapy
» Evidence and summary of findings
» Benefits and risks Acceptability and feasibility
» Evidence and summary of findings Benefits and risks
» Acceptability and feasibility Management of neonatal jaundice
» Benefits and risks Head or whole body cooling in management of hypoxic ischaemic
» Acceptability and feasibility Head or whole body cooling in management of hypoxic ischaemic
» Evidence and summary of recommendations
» Acceptability and feasibility Kangaroo Mother Care
» Benefits and risks Prevention of hypothermia immediately after birth in low birth
» Acceptability and feasibility Prevention of hypothermia immediately after birth in low birth
» Benefits and risks Antibiotic treatment for non-severe pneumonia with wheeze
» Acceptability and feasibility Antibiotic treatment for non-severe pneumonia with wheeze
» Benefits and risks Antibiotic treatment for non-severe pneumonia with no wheeze
» Acceptability and feasibility Antibiotic treatment for non-severe pneumonia with no wheeze
» Benefits and risks Antibiotics treatment for severe pneumonia
» Acceptability and feasibility Antibiotics treatment for severe pneumonia
» Evidence and summary of findings Benefits and risks Acceptability and feasibility
» Acceptability and feasibility Salbutamol for treatment of acute wheezeasthma and
» Acceptability and feasibility Antibiotics for treatment of acute bacterial meningitis
» Benefits and risks Antibiotic treatment for Acute Otitis Media AOM
» Acceptability and feasibility Antibiotic treatment for Chronic Suppurative Otitis Media CSOM
» Benefits and risks Topical steroids for treatment of Chronic Suppurative Otitis Media
» Acceptability and feasibility Topical steroids for treatment of Chronic Suppurative Otitis Media
» Benefits and risks Antibiotic treatment for Typhoid Fever
» Acceptability and feasibility: Antibiotic treatment for Typhoid Fever
» Benefits and risks Antibiotics use in the management of severe acute malnutrition
» Acceptability and feasibility Antibiotics use in the management of severe acute malnutrition
» Acceptability and feasibility: Oxygen therapy in treatment of hypoxaemia
» Acceptability and feasibility Oxygen therapy delivery methods
» Benefits and risks Criteria for starting and stopping oxygen therapy
» Acceptability and feasibility Criteria for starting and stopping oxygen therapy
» Benefits and risks Sublingual administration of sugar in treatment of hypoglycaemia
» Acceptability and feasibility Sublingual administration of sugar in treatment of hypoglycaemia
» Benefits and risks Choice of intravenous fluids for resuscitation and maintenance in
» Vitamin K prophylaxis in newborns
» Skin-to-skin contact in the first hour of life
» Management of neonatal jaundice
» Kangaroo Mother Care Outline of the research gaps
» Prevention of hypothermia immediately after birth in VLBW infants
» Management of children with non-severe pneumonia and wheeze
» Antibiotics for severe pneumonia
» Antibiotics for very severe pneumonia
» Treatment of non-severe pneumonia
» Problems of the neonate and young infant
» Fever Severe malnutrition Hospital Care WHO evidence 0
» Children with HIVAIDS Hospital Care WHO evidence 0
» Common surgical conditions Hospital Care WHO evidence 0
» Supportive care Hospital Care WHO evidence 0
» Monitoring the child’s progress
» Counselling and discharge from hospital
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