ESPE Yearbook of Paediatric Endocrinology

Cochrane Database Syst Rev. 2021 Dec 21;12(12):CD013309. doi: 10.1002/14651858.CD013309.pub3. PMID: 34931697.

Brief Summary: This systematic review assessed the evidence for continuous glucose monitoring (CGM) to prevent morbidity and mortality in preterm infants. There was uncertainty about the safety of CGM and the available management algorithms, and many morbidities remain unreported in this patient group.

Preterm infants are susceptible to hyperglycaemia and hypoglycaemia, which may lead to adverse neurodevelopment. The hypoglycaemia may be due to a consequence of immature gluconeogenesis and ketogenesis, and to hyperglycaemia due to impaired insulin response to glucose variations during the first days of life (1). The use of CGM devices might help in keeping glucose levels in the normal range, and reduce the need for blood sampling. However, the use of CGM might be associated with harms in the preterm infant.

Based on four identified studies, this review found insufficient evidence to determine if CGM impacts on preterm infant mortality or morbidities. There was uncertainty about the safety of CGM and the available management algorithms, and many morbidities remain unreported. Preterm infants at risk of hypoglycaemia or hyperglycaemia were enrolled in all four included studies. No studies had been conducted in preterm infants with proven hypoglycaemia or hyperglycaemia. Long-term outcomes were not reported. Hence, the effectiveness of CGM on this outcome remains very uncertain.

Clinical trials are required to determine the most effective CGM and glycaemic management regimens in preterm infants before larger studies can be performed to assess the effectiveness of CGM for reducing mortality, morbidity, and long-term neurodevelopmental impairments.

Reference: 1. Farrag HM, Cowett RM. Glucose homeostasis in the micropremie. Clinics in Perinatology 2000;27(1):1–22.