ESPE Yearbook of Paediatric Endocrinology

To read the full abstract: J Pediatr. 2020 May 4. pii: S0022-3476(20)30295-X. doi: 10.1016/j.jpeds.2020.02.079. [Epub ahead of print]. PMID:32381469

Understanding the typical patterns of blood glucose profiles in healthy term infants is needed to inform guidelines for the management of hypoglycaemia. Typically blood glucose levels fall rapidly after birth (30–90 min), then stabilize at 48 h, and eventually reach adult values after ^~4 days. Almost all previous studies assessing the changes in blood glucose after birth have been undertaken on infants in a hospital setting with intermittent blood or plasma glucose measurements, sampled at varying intervals, and therefore changes in glucose concentrations between sampling could not be captured.

Here, the authors measured blood glucose (heel prick) and also interstitial glucose levels (CGM started 2 h after birth) to understand the blood glucose profiles from birth to 5 days in a cohort of term healthy newborns. These newborns were born either in hospital, at a birthing center or at home, and were breast or bottle fed. There were are 2 distinct patterns in glucose concentrations, the first over the initial 18 h and the second after 48 h, reaching a new plateau by 96 h at concentrations similar to adult concentrations. These glucose profiles suggests that healthy infants complete their metabolic transition by day 4. Despite this overall pattern, blood glucose levels varied widely in individual patients, and infants appeared to take varying periods of time to stabilize their glucose concentrations, suggesting immature regulatory mechanisms during this transitional phase. More importantly, many healthy infants had glucose concentrations below the international recommended thresholds for treatment in at-risk infants. 39% of infants had episodes of low plasma glucose and 73% had episodes of low interstitial glucose concentrations during the first 48 h. As CGM technology becomes used more widely in the newborn this will allow a more detailed understanding of blood glucose profiles over time and will then inform decisions about the management of hypoglycaemia.