Continuous glucose monitoring during therapeutic hypothermia for hypoxic ischaemic encephalopathy: a feasibility study

Kalogeropoulou, Maria-Sofia; Thomson, Lynn; Beardsall, Kathryn

doi:10.1136/archdischild-2022-324593

Cited by 6 publications

(4 citation statements)

References 24 publications

(32 reference statements)

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“…Recently the use of continuous glucose monitoring has come to the fore in neonatology. Several studies have highlighted that this is a feasible adjunct to clinical care and may help to identify episodes of hypoglycaemia or hyperglycaemia, which would otherwise be clinically silent 9 29–31…”

Section: Discussionmentioning

confidence: 99%

Hypoglycaemia and hyperglycaemia in neonatal encephalopathy: a systematic review and meta-analysis

Puzone

Diplomatico

Caredda

et al. 2023

Arch Dis Child Fetal Neonatal Ed

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ImportanceAlthough hypoglycaemia and hyperglycaemia represent the most common metabolic problem in neonates, there is still uncertainty regarding the effects of glucose homoeostasis on the neurological outcomes of infants with neonatal encephalopathy (NE).ObjectiveTo systematically investigate the association between neonatal hypoglycaemia and hyperglycaemia with adverse outcome in children who suffered from NE.Study selectionWe searched Pubmed, Embase and Web of Science databases to identify studies which reported prespecified outcomes and compared infants with NE who had been exposed to neonatal hypoglycaemia or hyperglycaemia with infants not exposed.Data analysisWe assessed the risk of bias (ROBINS-I), quality of evidence (Grading of Recommendations, Assessment, Development and Evaluation (GRADE)) for each of the studies. RevMan was used for meta-analysis (inverse variance, fixed effects).Main outcomeDeath or neurodevelopmental outcomes at 18 months of age or later.Results82 studies were screened, 28 reviewed in full and 12 included. Children who were exposed to neonatal hypoglycaemia had higher odds of neurodevelopmental impairment or death (6 studies, 685 infants; 40.6% vs 25.4%; OR=2.17, 95% CI 1.46 to 3.25; p=0.0001). Neonatal exposure to hyperglycaemia was associated with death or neurodisability at 18 months or later (7 studies, 807 infants; 46.1% vs 28.0%; OR=3.07, 95% CI 2.17 to 4.35; p<0.00001). These findings were confirmed in the subgroup analysis, which included only the infants who underwent therapeutic hypothermia.ConclusionsThese data suggest that neonatal hypoglycaemia and hyperglycaemia may be associated with the neurodevelopmental outcome later on in infants with NE. Further studies with long-term follow-up are needed to optimise the metabolic management of these high-risk infants.PROSPERO registration numberCRD42022368870.

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Section: Discussionmentioning

confidence: 99%

Hypoglycaemia and hyperglycaemia in neonatal encephalopathy: a systematic review and meta-analysis

Puzone

Diplomatico

Caredda

et al. 2023

Arch Dis Child Fetal Neonatal Ed

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“…Implementation of CGM use as part of clinical decision making in HIE has not been explored, and needs to be preceded by validation of sensor accuracy during cooling. A recent study shows that CGM accuracy is comparable in normothermic and hypothermic conditions ( 31 ).…”

Section: What Types Of Neonates May Benefit?mentioning

confidence: 99%

Should continuous glucose monitoring be used to manage neonates at risk of hypoglycaemia?

2023

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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.

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“…Also, several studies have shown that initial dysglycemia has been detected in infants with neonatal encephalopathy. A few studies have suggested that hyperglycemia associated with HIE may affect brain microstructure and seizures [32][33][34][35]. It is also recognised that hypoglycemia is associated with neonatal brain injury [32,33,36].…”

Section: Glucose Metabolismmentioning

confidence: 99%

“…A few studies have suggested that hyperglycemia associated with HIE may affect brain microstructure and seizures [32][33][34][35]. It is also recognised that hypoglycemia is associated with neonatal brain injury [32,33,36]. Further research in this area is required to fully understand the role of dysglycemia in HIE.…”

Section: Glucose Metabolismmentioning

confidence: 99%

Newborns with Favourable Outcomes after Perinatal Asphyxia Have Upregulated Glucose Metabolism-Related Proteins in Plasma

Yip,

Bremang,

Pike

et al. 2023

Biomolecules

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Hypoxic-ischaemic encephalopathy (HIE) is an important cause of morbidity and mortality globally. Although mild therapeutic hypothermia (TH) may improve outcomes in selected babies, the mechanism of action is not fully understood. A proteomics discovery study was carried out to analyse proteins in the plasma of newborns with HIE. Proteomic analysis of plasma from 22 newborns with moderate-severe HIE that had initially undergone TH, and relative controls including 10 newborns with mild HIE who did not warrant TH and also cord blood from 10 normal births (non-HIE) were carried out using the isobaric Tandem Mass Tag (TMT®) 10plexTM labelling with tandem mass spectrometry. A total of 7818 unique peptides were identified in all TMT10plexTM samples, translating to 3457 peptides representing 405 proteins, after applying stringent filter criteria. Apart from the unique protein signature from normal cord blood, unsupervised analysis revealed several significantly regulated proteins in the TH-treated moderate-severe HIE group. GO annotation and functional clustering revealed various proteins associated with glucose metabolism: the enzymes fructose-bisphosphate aldolase A, glyceraldehyde-3-phosphate dehydrogenase, phosphoglycerate mutase 1, phosphoglycerate kinase 1, and pyruvate kinase PKM were upregulated in newborns with favourable (sHIE+) outcomes compared to newborns with unfavourable (sHIE−) outcomes. Those with favourable outcomes had normal MR imaging or mild abnormalities not predictive of adverse outcomes. However, in comparison to mild HIE and the sHIE− groups, the sHIE+ group had the additional glucose metabolism-related enzymes upregulated, including triosephosphate isomerase, α-enolase, 6-phosphogluconate dehydrogenase, transaldolase, and mitochondrial glutathione reductase. In conclusion, our plasma proteomic study demonstrates that TH-treated newborns with favourable outcomes have an upregulation in glucose metabolism. These findings may open new avenues for more effective neuroprotective therapy.

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Continuous glucose monitoring during therapeutic hypothermia for hypoxic ischaemic encephalopathy: a feasibility study

Cited by 6 publications

References 24 publications

Hypoglycaemia and hyperglycaemia in neonatal encephalopathy: a systematic review and meta-analysis

Hypoglycaemia and hyperglycaemia in neonatal encephalopathy: a systematic review and meta-analysis

Should continuous glucose monitoring be used to manage neonates at risk of hypoglycaemia?

Newborns with Favourable Outcomes after Perinatal Asphyxia Have Upregulated Glucose Metabolism-Related Proteins in Plasma

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