The National Institute for Clinical Excellence (NICE) now recommends that continuous glucose monitoring (CGM) be offered to adults and children with diabetes who are at risk from hypoglycaemia. Hypoglycaemia is common in the neonatal period, and is a preventable cause of poor neurodevelopmental outcome, but is CGM helpful in the management of neonates at risk of hypoglycaemia? Neonatal studies have shown that CGM can detect clinically silent hypoglycaemia, which has been associated with reduced executive and visual function in early childhood. Intervention trials have further shown CGM can support the targeting of glucose levels in high-risk extremely preterm neonates. In spite of significant advances in technology, including smaller sensors, better accuracy and factory calibration, further progress and adoption into clinical practice has been limited as current devices are not designed nor have regulatory approval for the specific needs of the newborn. The use of CGM has the potential to support clinical management, and prevention of hypoglycaemia but must be set within its current limitations. The data CGM provides however also provides an important opportunity to improve our understanding of potential risks of hypoglycaemia and the impact of clinical interventions to prevent it.

ObjectivesGlucose dysregulation is common in infants with hypoxic ischaemic encephalopathy (HIE) and is likely to exacerbate cerebral injury. Infrequent measurement of glucose concentrations makes both identification and prevention of this risk challenging. Continuous glucose monitoring (CGM) has the potential to address both these challenges, but has not been explored in these infants. We aimed to evaluate the feasibility and potential impact of real-time CGM in term infants with HIE being treated with therapeutic hypothermia (TH).DesignFeasibility study.SettingTertiary-level neonatal unit, UK.PatientsTerm infants with HIE undergoing TH.InterventionA CGM sensor was inserted within 48 hours of birth and kept in situ for the first week of life. Clinical staff were blinded to the CGM recordings and clinical decisions were based on blood glucose assays.Main outcome measures(1) Accuracy of CGM values during and post TH, (2) Per cent of time spent outside the clinical range (2.6–10 mmol/L), (3) Episodes of hypoglycaemia and hyperglycaemia, (4) Adverse effects.ResultsThe accuracy of CGM values during TH were comparable to those when infants were normothermic. There was wide variation in per cent time outside the target range (2.6–10 mmol/L) between infants (median 5%, range 0%–34%). CGM identified 44% of infants with ≥1 episode of hypoglycaemia (<2.6 mmol/L) and 50% with ≥1 episode of hyperglycaemia (>10 mmol/L). No adverse events were observed.ConclusionsThis study demonstrates that CGM could be a useful adjunct for glucose monitoring in babies undergoing TH who are at risk of both hypoglycaemia and hyperglycaemia.