Continuous glucose monitoring in neonates: a review

Abstract

Continuous glucose monitoring (CGM) is well established in the management of diabetes mellitus, but its role in neonatal glycaemic control is less clear. CGM has provided important insights about neonatal glucose metabolism, and there is increasing interest in its clinical use, particularly in preterm neonates and in those in whom glucose control is difficult. Neonatal glucose instability, including hypoglycaemia and hyperglycaemia, has been associated with poorer neurodevelopment, and CGM offers the possibility of adjusting treatment in real time to account for individual metabolic requirements while reducing the number of blood tests required, potentially improving long-term outcomes. However, current devices are optimised for use at relatively high glucose concentrations, and several technical issues need to be resolved before real-time CGM can be recommended for routine neonatal care. These include: 1) limited point accuracy, especially at low or rapidly changing glucose concentrations; 2) calibration methods that are designed for higher glucose concentrations of children and adults, and not for neonates; 3) sensor drift, which is under-recognised; and 4) the need for dynamic and integrated metrics that can be related to long-term neurodevelopmental outcomes. CGM remains an important tool for retrospective investigation of neonatal glycaemia and the effect of different treatments on glucose metabolism. However, at present CGM should be limited to research studies, and should only be introduced into routine clinical care once benefit is demonstrated in randomised trials.

Neonatal Hypoglycemia Following Diet-Controlled and Insulin-Treated Gestational Diabetes Mellitus

“…Studies with premature neonates in the intensive care unit show that CGM use detects more hypoglycemic episodes than repeated blood glucose measurements (20). However, CGM may currently not yet be the proper tool for screening infants born from mothers with GDM in daily practice due to the limited accuracy, especially in the hypoglycemic range, and the demanding and expensive nature of the technique (21).…”

Neonatal Glycaemia and Neurodevelopmental Outcomes: A Systematic Review and Meta-Analysis

“…All studies require the use of gold standard glucose assay methods [25, 47] and long-term follow-up at least to school age, with attention to visual-motor and executive function, and educational achievement. Consideration should be given to the use of masked continuous glucose monitoring to aid in the interpretation of study results, although retrospective point-to-point recalibration against all laboratory blood glucose values is important for accurate interstitial measurements in babies [48]. …”

The fetus at the tipping point: modifying the outcome of fetal asphyxia

“…) and preterm infants (McKinlay et al . ; Sharma et al . ), show highly variable blood glucose levels during the early period after birth, and a current clinical challenge is to understand what constitutes euglycaemia and how fluctuating glucose may contribute to NE and thus how best to manage changes in glucose (Ogilvy‐Stuart & Beardsall, ).…”