Glucose Monitoring With Long-Term Subcutaneous  Microdialysis in Neonates

Baumeister, F. A. M.; Rolinski, Boris; Busch, Raymonde; Emmrich, P

doi:10.1542/peds.108.5.1187

Cited by 54 publications

(39 citation statements)

References 25 publications

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“…39 These are especially impressive performance characteristics given CGM accuracy (particularly for hypoglycemia) at the time and results should be confirmed with modern CGM systems.…”

Section: Cgm In Pediatrics Clinical Use S-39mentioning

confidence: 91%

Clinical Use of Continuous Glucose Monitoring in Pediatrics

Lal

Maahs

2017

Diabetes Technology & Therapeutics

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“…39 These are especially impressive performance characteristics given CGM accuracy (particularly for hypoglycemia) at the time and results should be confirmed with modern CGM systems.…”

Section: Cgm In Pediatrics Clinical Use S-39mentioning

confidence: 91%

Clinical Use of Continuous Glucose Monitoring in Pediatrics

Lal

Maahs

2017

Diabetes Technology & Therapeutics

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“…The molecular exclusion size of the polyamide membrane was 20 kD. According to the application in neonates and children (16,17), the MD catheters were inserted under sterile conditions upon transdermal local anesthesia (EMLA, Wedel, Germany) into the s.c. tissue of the lateral thigh (younger children) or the forearm (older children). Intravenous plastic cannulas (Vasofix Braunüle, 18 G; Braun Melsungen, Melsungen, Germany) were used as guides.…”

Section: Methodsmentioning

confidence: 99%

Monitoring of Ketogenic Diet for Carnitine Metabolites by Subcutaneous Microdialysis

et al. 2006

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ABSTRACT:The ketogenic diet (KD) provides ketones from the degradation of free fatty acids for energy metabolism. It is a therapeutic option for pharmacoresistant epilepsies. Carnitine is the carrier molecule that transports fatty acids across the mitochondrial membrane for degradation into ketones. The integrity of this transport system is a prerequisite for an adequate ketogenic response. For monitoring of tissue metabolism with KD, we used the sampling method of s.c. microdialysis (MD), which permits minimally invasive, frequent, and extensive metabolic monitoring independent of blood tests. By using this new method, we monitored changes in carnitine metabolism induced by KD, particularly in free carnitine (C0), acetylcarnitine (C2), and hydroxybutyrylcarnitine (C4OH). Correlation of microdialysate and tissue concentrations for carnitines in vitro was about 85%. Carnitine metabolism was monitored in seven children started on a KD for pharmacoresistant epilepsy after a conventional initial fasting period. Detected metabolic changes consisted of a slight decrease in s.c. C0 and a marked increase in C2/CO and C4OH/CO levels. The levels of s.c. C4OH strongly correlate with ␤-hydroxybutyrate (␤-OHB) levels in plasma providing an additional parameter for the carnitine reserve of the body and reflect an optimal ketogenic energy supply. Subcutaneous MD allows close and extensive monitoring of metabolism with a KD. A high-fat, low-carbohydrate KD has been proven to be efficient for intractable childhood epilepsies (1). The metabolic effects of the KD are comparable to prolonged fasting. Glucose substrates are replaced by ␤-OHB, acetoacetate, and free fatty acids. Carnitine plays a major role in the degradation of fatty acids. As a trimethylated amino acid, it facilitates translocation of fatty acids into the mitochondrion and is therefore an essential cofactor in fatty acid oxidation and ketogenesis (2). In mammals, changes in the carnitine pattern in plasma and several tissues have been demonstrated with alterations in nutritional state. Studies in humans have shown a delayed decrease in plasma free carnitine and a rapid increase in long-and particularly short-chain acylcarnitines during fasting or diabetic ketosis (3)(4)(5). A study in children demonstrated that the changes in acylcarnitines during fat load (ingestion of sunflower oil) are more or less comparable to those during fasting (6). However, studies on the dynamics of carnitine metabolism, in particular C4OH, during initiation of a KD have not been reported so far.The technique of MD is a potent tool for the study of tissue metabolism. The method is based on the diffusion of substances through a semipermeable dialysis membrane implanted in the tissue of interest. It allows repeated measurement of the concentrations of tissue molecules that have crossed the membrane. Water-soluble analytes with a molecular weight below the exclusion size of the catheter cross the membrane until their concentrations in the extracellular fluid and the microdialysate are equal ...

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“…Bedside analyses were performed on a CMA 600 Microdialysis Analyzer (CMA/Microdialysis AB, Solna, Sweden). The microdialysis procedure and point-of-care glucose analyses of the dialysate were performed as described previously [8] . Briefl y, the microdialysis catheter was introduced into subcutaneous adipose tissue of the lateral thigh after transdermal local anesthesia with a 24-gauge intravenous catheter.…”

Section: Methodsmentioning

confidence: 99%

“…Such systems continuously perfuse dialysis fl uid through a semipermeable subcutaneous catheter and recollect the dialysate for point-of-care analysis. A good correlation between subcutaneous and blood glucose levels was observed in newborns and the procedure was suggested to reduce painful blood sampling and blood loss [8] .…”

Section: Introductionmentioning

confidence: 96%

Use of Long-Term Microdialysis Subcutaneous Glucose Monitoring in the Management of Neonatal Diabetes

et al. 2006

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In neonatal diabetes mellitus (NDM), a rare genetic disorder, insulin therapy is required but the management is difficult. Frequent blood glucose determinations are necessary in most cases. Microdialysis subcutaneous glucose monitoring (MSGM) is feasible in neonates and has been proposed to reduce painful blood sampling and blood loss. We have applied long-term MSGM to a small-for-date female newborn with transient NDM. We found a good correlation of subcutaneous and blood glucose concentration over a wide range of values. MSGM enabled a reduction in blood glucose determinations during optimization of intravenous insulin treatment and initiation of continuous subcutaneous insulin infusion. We conclude that long-term MSGM is feasible and may reduce painful blood sampling and blood loss in NDM. Furthermore, long-term MSGM may hold a potential for avoiding hypoglycemic episodes and earlier discharge.

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Glucose Monitoring With Long-Term Subcutaneous Microdialysis in Neonates

Abstract: Subcutaneous microdialysis is a safe method, well suited for long-term glucose monitoring in neonates during intensive care. Subcutaneous microdialysis can be used to reduce blood loss and painful stress resulting from diagnostic blood sampling in high-risk neonates.

Cited by 54 publications

References 25 publications

Clinical Use of Continuous Glucose Monitoring in Pediatrics

Clinical Use of Continuous Glucose Monitoring in Pediatrics

Monitoring of Ketogenic Diet for Carnitine Metabolites by Subcutaneous Microdialysis

Use of Long-Term Microdialysis Subcutaneous Glucose Monitoring in the Management of Neonatal Diabetes

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