ISSN 1662-4009 (online)

ESPE Yearbook of Paediatric Endocrinology (2020) 17 2.4 | DOI: 10.1530/ey.17.2.4

ESPEYB17 2. Antenatal and Neonatal Endocrinology Neonatal Hypoglycaemia (5 abstracts)

2.4. Targeting glucose control in preterm infants: Pilot studies of continuous glucose monitoring

Thomson L , Elleri D , Bond S , Howlett J , Dunger DB & Beardsall K



To read the full abstract: Arch Dis Child Fetal Neonatal Ed. 2019 Jul;104(4):F353–F359. PMID:30232094.

In preterm and in the very low birthweight infants, hyperglycaemia is associated with increased risks of mortality, brain injury, retinopathy of prematurity and worse neurodevelopmental outcomes (1). Treatment of hyperglycaemia with continuous insulin infusion leads to increased episodes of hypoglycaemia which in itself can potentially lead to brain damage. In addition, glycaemic variability is also associated with impaired long-term outcomes. Therefore, the use of continuous (interstitial) glucose monitoring (CGM) in very preterm, low birth weight infants has the potential to minimise the incidence and severity of hypoglycaemia and hyperglycaemia. This would allow glycaemic stability during critical developmental periods and provide new opportunities to improve long-term neurocognitive outcomes in these children.

The results of this this study are consistent with other studies showing that the CGM sensor was well tolerated, was acceptable to staff caring for the infants and, when combined with an algorithm informing clinical decisions based on real time-CGM data, allowed clinicians to keep glucose concentrations in these preterm infants within a narrower range. This last finding, combined with the ability of CGM to uncover episodes of occult hypoglycaemia, is an important reason why the use of CGM in the care of the very low weight preterm infant has been considered.

However, before GCM can be used widely in the neonatal period (and especially in the preterm very low birth weight baby) there are several important points that need to be considered. The current CGM algorithms used to derive interstitial glucose concentrations are based on interstitial glucose–blood glucose kinetics in adults and these have not been fully tested in the neonatal period. Further advances in CGM technology should focus on detecting low (0–2.6 mmol/l) blood glucose levels as these are more common in the late preterm and very low birthweight infants in the first a few days after birth. As CGM technology improves, this should allow more accurate assessment of blood glucose levels in the preterm and very low birthweight and improve outcome.

Reference:

1. Bottino M, Cowett RM, Sinclair JC. Interventions for treatment of neonatal hyperglycemia in very low birth weight infants. Cochrane Database Syst Rev 2009;1:CD007453.

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