Continuous subcutaneous glucose monitoring is accurate in term and near‐term infants at risk of hypoglycaemia

Wackernagel, Dirk; Dube, Martina; Blennow, Mats; Tindberg, Ylva

doi:10.1111/apa.13479

Cited by 22 publications

(19 citation statements)

References 20 publications

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“…Continuous glucose monitoring (CGM), although still experimental, is emerging as the new standard of care for monitoring blood glucose in tiny babies. The CGM device measures and updates blood glucose values every 5 minutes, providing real time data (42,47). Once a reliable (46).…”

Section: Approach To Diagnosis and Management Of Hypoglycemia In The mentioning

confidence: 99%

Hypoglycemia in the preterm neonate: etiopathogenesis, diagnosis, management and long-term outcomes

Sharma¹,

Davis²,

Shekhawat³

2017

Transl. Pediatr

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Glucose, like oxygen, is of fundamental importance for any living being and it is the major energy source for the fetus and the neonate during gestation. The placenta ensures a steady supply of glucose to the fetus, while birth marks a sudden change in substrate delivery and a major change in metabolism. Hypoglycemia is one of the most common pathologies encountered in the neonatal intensive care unit and affects a wide range of neonates. Preterm, small for gestational age (GA) and intra-uterine growth restricted neonates are especially vulnerable due to their lack of metabolic reserves and associated co-morbidities. Nearly 30-60% of these high-risk infants are hypoglycemic and require immediate intervention. Preterm neonates are uniquely predisposed to developing hypoglycemia and its associated complications due to their limited glycogen and fat stores, inability to generate new glucose using gluconeogenesis pathways, have higher metabolic demands due to a relatively larger brain size, and are unable to mount a counter-regulatory response to hypoglycemia. In this review we will discuss the epidemiology; pathophysiology; clinical presentation; management and neurodevelopmental outcomes in affected infants and summarize evidence to develop a rational and scientific approach to this common problem.

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Section: Approach To Diagnosis and Management Of Hypoglycemia In The mentioning

confidence: 99%

Hypoglycemia in the preterm neonate: etiopathogenesis, diagnosis, management and long-term outcomes

Sharma¹,

Davis²,

Shekhawat³

2017

Transl. Pediatr

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“…Other neonatal CGM studies were performed on preterm infants without maternal CGM (21), or which included offspring of mothers with diabetes, either did not specify the diabetes type (34) or included only small numbers of T1D offspring (n=3) (35). These studies did not include details of maternal glucose control and did not specify the timing of CGM initiation.…”

Section: Discussionmentioning

confidence: 99%

A Feasibility Study of Paired Continuous Glucose Monitoring Intrapartum and in the Newborn in Pregnancies Complicated by Type 1 Diabetes

Stewart

Thomson

Murphy

et al. 2019

Diabetes Technology & Therapeutics

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To describe the continuous glucose monitoring (CGM) profiles of type 1 diabetes (T1D) offspring in the early neonatal period and its association with maternal intrapartum glucose control. Methods: A prospective observational study of T1D pregnant women and their neonatal offspring. Women had a CGM sensor inserted 2-3 days prior to delivery. Infants had a masked CGM sensor inserted as soon as possible following delivery. Maternal glycaemic outcomes were time-in-target (70-140 mg/dL [3.9-7.8 mmol/L]), hyperglycaemia >140 mg/dL (7.8 mmol/L) and mean CGM glucose during the 24 hours preceding delivery. Neonatal outcomes included lowest recorded blood glucose concentration, and CGM measures (glucose <47 mg/dL [2.6 mmol/L], time-in-target (47-144 mg/dL [2.6-8.0 mmol/L]), glucose SD) during the first 72 hours of life. Results: Data were available for 16 mother-infant pairs. Mothers had a mean age (SD) 32.3 (4.3) years, T1D duration 17.6 (6.8) years, first antenatal HbA1c 7.4 (0.8)% (57 [8.5] mmol/mol). In the 24 hours preceding delivery, mothers spent mean (SD) 72 (20) % time-intarget (70-140 mg/dL [3.9-7.8 mmol/L]), 19 (15) % time >140 mg/dL (7.8 mmol/L), and 9 (9) % time < 70 mg/dL (3.9 mmol/L) with mean (SD) CGM glucose 113 (9) mg/dL (6.3 [0.7] mmol/L). 15 infants (93.8%) had ≥1 blood glucose concentration < 47 mg/dL (2.6 mmol/L) and five had ≥1 blood glucose concentration < 18 mg/dL (1.0 mmol/L). The mean infant CGM glucose on days 1, 2, and 3 of life was 63 (14), 67 (13), 76 (11) mg/dL (3.5 [0.8], 3.7 [0.7], and 4.2 [0.6] mmol/L). Four infants (25%) spent more than 50% time with CGM glucose levels < 47 mg/dL (2.6 mmol/L) on day 1. Conclusions: CGM detected widespread neonatal hypoglycaemia, even among mothers with good intrapartum glucose control. .

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“…The method needs to be regularly calibrated against blood samples and is primarily seen as a screening method, where deviating or unexpected readings have to be confirmed with blood samples that are analysed with a validated method. [80][81][82] Its feasibility as a screening tool in newborn infants of diabetic mothers has recently been studied. 83…”

Section: Consensus Recommendationmentioning

confidence: 99%

Swedish national guideline for prevention and treatment of neonatal hypoglycaemia in newborn infants with gestational age ≥35 weeks

et al. 2019

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Aim Postnatal hypoglycaemia in newborn infants remains an important clinical problem where prolonged periods of hypoglycaemia are associated with poor neurodevelopmental outcome. The aim was to develop an evidence‐based national guideline with the purpose to optimise prevention, diagnosis and treatment of hypoglycaemia in newborn infants with a gestational age ≥35 + 0 weeks. Methods A PubMed search‐based literature review was used to find actual and applicable evidence for all incorporated recommendations. The GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach was used for grading the evidence of the recommendations. Results Recommendations for the prevention of neonatal hypoglycaemia were extended and updated, focusing on promotion of breastfeeding as one prevention strategy. Oral dextrose gel as a novel supplemental therapy was incorporated in the treatment protocol. A new threshold‐based screening and treatment protocol presented as a flow chart was developed. Conclusion An updated and evidence‐based national guideline for screening and treatment of neonatal hypoglycaemia will support standardised regimes, which may prevent hypoglycaemia and the risk for hypoglycaemia‐related long‐term sequelae.

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Continuous subcutaneous glucose monitoring is accurate in term and near‐term infants at risk of hypoglycaemia

Cited by 22 publications

References 20 publications

Hypoglycemia in the preterm neonate: etiopathogenesis, diagnosis, management and long-term outcomes

Hypoglycemia in the preterm neonate: etiopathogenesis, diagnosis, management and long-term outcomes

A Feasibility Study of Paired Continuous Glucose Monitoring Intrapartum and in the Newborn in Pregnancies Complicated by Type 1 Diabetes

Swedish national guideline for prevention and treatment of neonatal hypoglycaemia in newborn infants with gestational age ≥35 weeks

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