Capillary Blood Ketone Levels as an Indicator of Inadequate Breast Milk Intake in the Early Neonatal Period

Futatani, Takeshi; Shimao, Ayako; Ina, Shihomi; Higashiyama, Hiroyuki; Fujita, Shuhei; Ueno, K.; Igarashi, Noboru; Hatasaki, Kiyoshi

doi:10.1016/j.jpeds.2017.08.080

Cited by 13 publications

(30 citation statements)

References 31 publications

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“…Those changes were synchronized with the changes in bodyweight loss percentage, indicating that blood sodium and ketone levels reflect the sufficiency of breast milk intake. This agrees with our previous observation that blood ketone level is associated with the sufficiency of breast milk intake . Blood sodium and ketone dropped to lowest levels at 120–143 h of life, suggesting that by this time, breast milk supply becomes sufficient enough to suppress ketone production and to recover the body water loss.…”

Section: Discussionsupporting

confidence: 80%

“…In our previous study, blood β‐OHB 1.85 mmol/L was identified as the optimal cut‐off for detecting hypernatremic dehydration . In the present study, the 90th percentile of β‐OHB at 48–59 h of life was 1.80 mmol/L, similar to the cut‐off for detecting hypernatremic dehydration.…”

Section: Discussioncontrasting

confidence: 68%

“…Hypoglycemia, defined as blood glucose <47 mg/dL, was often observed during the period of weight nadir in the present study, indicating that even in neonates with normal weight loss, hypoglycemia is not a rare phenomenon in exclusively breast‐fed neonates. These neonates, however, had elevated blood ketones, and not display symptoms associated with hypoglycemia . Blood glucose level was inversely correlated with blood ketone level.…”

Section: Discussionmentioning

confidence: 99%

“…We analyzed data pertaining to blood samples obtained from neonates born at Toyama Prefectural Central Hospital between March 2012 and June 2015. Some of the data used in this study were included in a previous report we conducted during the same period . All the neonates included in the present study were born at 37–41 weeks of gestation, appropriate for gestational age (AGA; birthweight 10th–90th percentile), singleton, had Apgar score >7 at 1 min, were exclusively breast‐fed (breast milk only, with no other fluids or solids), and had a maximum weight loss <10% of birthweight.…”

Section: Methodsmentioning

confidence: 99%

“…Ketone bodies, produced by the liver from fatty acids when nutrient supplies are deficient, serve as an alternative to glucose as fuel for the brain. Inadequate breast milk intake not only results in an elevation of blood sodium but also in blood ketone . Therefore, blood ketone level can be an indicator of breast‐feeding‐associated dehydration, but little is known about the physiological levels of blood ketones during the early postnatal period.…”

mentioning

confidence: 99%

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Exclusive breast‐feeding and postnatal changes in blood sodium, ketone, and glucose levels

Futatani

Ina

Shimao

et al. 2019

Pediatrics International

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Background Blood sodium and ketone are parameters of dehydration and fasting, respectively. Little is known, however, about the postnatal changes in these parameters in healthy, term, exclusively breast‐fed neonates. Methods Capillary blood sodium, β‐hydroxybutyrate (β‐OHB), and glucose levels in 628 samples obtained from 392 healthy, term, exclusively breast‐fed neonates during the first 12–143 h of life were examined. Results Blood sodium and β‐OHB gradually increased and reached a peak at 48–59 h of life (mean blood sodium, 142.3 ± 2.8 mEq/L; mean blood sodium increase, 3.3 mEq/L; mean β‐OHB, 1.16 ± 0.46 mmol/L; mean β‐OHB increase, 0.65 mmol/L), and then gradually decreased and reached a nadir at 120–143 h of life. Blood glucose gradually decreased and reached a nadir at 48–59 h of life (mean, 62.4 ± 12.2 mg/dL; mean decrease, 4.7 mg/dL), and then gradually increased and peaked at 120–143 h of life. These changes were synchronized with changes in weight‐loss percentage. Conclusions The postnatal changes in blood sodium, ketone, and glucose levels during the first 12–143 h of life are described in healthy, term, exclusively breast‐fed neonates. The parameters seemed to be associated with the sufficiency of the breast‐milk supply. These results can serve as normal reference values for healthy, term, exclusively breast‐fed neonates during the early postnatal period.

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Section: Discussionsupporting

confidence: 80%

Section: Discussioncontrasting

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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Exclusive breast‐feeding and postnatal changes in blood sodium, ketone, and glucose levels

Futatani

Ina

Shimao

et al. 2019

Pediatrics International

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Severe neuroglycopenic symptoms due to nonketotic hypoglycemia in children with cardio‐facio‐cutaneous syndrome

Shiohama

Fujii

Kosaki

et al. 2022

American J of Med Genetics Pt A

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Cardio-facio-cutaneous syndrome (CFC) (OMIM 115150) is a congenital disease caused by constitutive activation of the Raf/MEK/ERK signaling cascade. Unlike aspects of morphological anomalies, metabolic functions related to the disease have garnered little attention. We present severe neuroglycopenic symptoms due to nonketotic hypoglycemia in two children with CFC (Case 1, a 4-year-old male with c.389A > G heterozygous variant in MAP2K1; Case 2, a 3-year-old male with c.770A > G heterozygous variant in BRAF). Case 1 exhibited a nonketotic hypoglycemic coma and clustered left-hemispheric convulsions despite receiving infusion therapy, leading to severe sequelae with choreoathetosis. Brain magnetic resonance imaging of Case 1 showed T2-elongation with restricted diffusion on the bilateral basal ganglia and thalamus, with the dominance of the right putamen. Case 2 presented a prolonged generalized seizure as an initial clinical symptom but fully recovered. The presence of growth hormone and cortisol deficiency was ruled out in both cases. Blood spots acylcarnitine profiles excluded the co-occurrence of mitochondrial HMG-CoA synthase deficiency and HMG-CoA lyase deficiency. These cases demonstrate the potential vulnerability to nonketotic hypoglycemia, especially during lipid shortages. As children with CFC frequently have difficulties feeding, we suggest great attention should be paid to the potential risk of severe nonketotic hypoglycemia.

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The timing of 40% oral dextrose gel administration after birth does not influence the incidence of hypoglycemia in at-risk infants

Giuseppe,

Maurizio,

Carmen

et al. 2024

Global Pediatrics

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Capillary Blood Ketone Levels as an Indicator of Inadequate Breast Milk Intake in the Early Neonatal Period

Cited by 13 publications

References 31 publications

Exclusive breast‐feeding and postnatal changes in blood sodium, ketone, and glucose levels

Exclusive breast‐feeding and postnatal changes in blood sodium, ketone, and glucose levels

Severe neuroglycopenic symptoms due to nonketotic hypoglycemia in children with cardio‐facio‐cutaneous syndrome

The timing of 40% oral dextrose gel administration after birth does not influence the incidence of hypoglycemia in at-risk infants

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