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Table of Contents
Vol. 95, No. 3, 2009
Issue release date: March 2009
Neonatology 2009;95:217–223
(DOI:10.1159/000165980)

Continuous Glucose Monitoring in Infants of Very Low Birth Weight

Iglesias Platas I. · Thió Lluch M. · Pociello Almiñana N. · Morillo Palomo A. · Iriondo Sanz M. · Krauel Vidal X.
aNeonatal Unit, Hospital Sant Joan de Déu, Fundació Sant Joan de Déu, Barcelona University, Barcelona, and bDivision of Pediatrics, Hospital Arnau de Vilanova, Lleida, Spain

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Abstract

Objectives: To evaluate the feasibility and efficacy of a continuous glucose monitoring system (CGMS) in a population of infants of very low birth weight (VLBW). Study Design: Infants weighing ≤1,500 g and of ≤32 weeks of gestation were recruited within 24 h of delivery. A subcutaneous sensor connected to a CGMS was inserted and maintained for 7 days or until dysfunction. Therapeutic management followed the usual standard protocols. Results: 38 patients (21 male) were included over 17 months. Their mean gestational age was 27.5 ± 2.0 weeks and their mean birth weight was 958.3 ± 205.5 g. Their perinatal histories and complications during admission were unremarkable for extremely premature babies. Continuous monitoring lasted an average of 7.84 ± 1.99 days per patient. Hyperglycaemia was detected in 22 (57.90%) patients and it lasted a mean of 20.33 ± 30.13 h, while 14 (36.8%) presented with hypoglycaemia for a mean of 2.45 ± 2.3 h. Conclusions: The CGMS gave a safe and useful estimate of glucose levels in VLBW infants, revealing abnormal glucose levels at a much higher rate than expected by usual sampling. However, it was not able to provide real-time glucose concentration data. CGMS may be very useful in providing information on the role of hyper- and hypoglycaemia on short- and long-term outcomes in VLBW infants.



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References

  1. Ho HT, Yeung WKY, Young BWY: Evaluation of ‘point of care’ devices in the measurement of low blood glucose in neonatal practice. Arch Dis Child Fetal Neonatal Ed 2004;89:F356–F359.
  2. Rosenthal M, Ugele B, Lipowsky G, Küster H: The Accutrend sensor glucose analyzer may not be adequate in bedside testing for neonatal hypoglycemia. Eur J Pediatr 2006;165:99–103.
  3. Baumeister FA, Rolinski B, Busch R, Emmrich P: Glucose monitoring with long-term subcutaneous microdialysis in neonates. Pediatrics 2001;108:1187–1192.
  4. Cornblath M, Ichord R: Hypoglycemia in the neonate. Semin Perinatol 2000;24:136–149.
  5. Tyrala EE, Chen X, Boden G: Glucose metabolism in the infant weighing less than 1,100 grams. J Pediatr 1994;125:283–287.
  6. Ward Platt M, Deshpande S: Metabolic adaptation at birth. Semin Fetal Neonatal Med 2005;10:341–350.
  7. Van Kempen AAMW, Romijn JA, Ruiter AFC, Ackermans MT, Endert E, Hoekstra JH, Kok JH, Sauerwein HP: Adaptation of glucose production and gluconeogenesis to diminishing glucose infusion in preterm infants at varying gestational ages. Pediatr Res 2003;53:628–634.
  8. Menni F, de Lonlay P, Sevin C, Touati G, Peigné C, Barbier V, Nihoul-Fékété C, Saudubray JM: Neurologic outcomes of 90 neonates and infants with persistent hyperinsulinemic hypoglycemia. Pediatrics 2001;107:476–479.
  9. Kinnala A, Rikalainen H, Lapinleimu H, Parkkola R, Kormano M, Kero P: Cerebral magnetic resonance imaging and ultrasonography findings after neonatal hypoglycemia. Pediatrics 1999;103:724–729.
  10. Vannucci RC, Vannucci SJ: Hypoglycemic brain injury. Semin Neonatol 2001;6:147–155.
  11. Lucas A, Morley R, Cole TJ: Adverse neurodevelopmental outcome of moderate neonatal hypoglycaemia. BMJ 1988;297:304–308.

    External Resources

  12. Cowett RM, Farrag HM: Selected principles of perinatal-neonatal glucose metabolism. Semin Neonatol 2004;9:37–47.
  13. Mitanchez-Mokhtari D, Lahlou N, Kieffer F, Magny JF, Roger M, Voyer M: Both relative insulin resistance and defective islet β-cell processing of proinsulin are responsible for transient hyperglycemia in extremely preterm infants. Pediatrics 2004;113:537–541.
  14. Hays SP, Smith EO, Sunehag AL: Hyperglycemia is a risk factor for early death and morbidity in extremely low birth-weight infants. Pediatrics 2006;118:1811–1818.
  15. Van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, Vlasselaers D, Ferdinande P, Lauwers P, Bouillon R: Intensive insulin therapy in the critically ill patients. N Engl J Med 2001;345:1359–1367.
  16. Van den Berghe G, Wouters PJ, Bouillon R, Weekers F, Verwaest C, Schetz M, Weekers F, Vlasselaers D, Ferdinande P, Lauwers P: Outcome benefit of intensive insulin therapy in the critically ill: insulin dose versus glycemic control. Crit Care Med 2003;31:359–366.
  17. Michel A, Küster H, Krebs A, Kadow I, Paul W, Nauck M, Fusch C: Evaluation of the Glucometer Elite XL device for screening for neonatal hypoglycaemia. Eur J Pediatr 2005;164:660–664.
  18. Alexander GR, Himes JH, Kaufman RB, Mor J, Kogan M: A United States national reference for fetal growth. Obstet Gynecol 1996;87:163–168.
  19. Carrascosa A: Crecimiento intrauterino: factores reguladores. Retraso de crecimiento intrauterino. An Pediatr 2003;58(suppl 2): 55–73.
  20. Piper HG, Alexander JL, Shukla A, Pigula F, Costello JM, Laussen PC, Jaksic T, Agus MSD: Real-time continuous glucose monitoring in pediatric patients during and after cardiac surgery. Pediatrics 2006;118:1176–1184.
  21. Jefferies C, Solomon M, Perlman K, Sweezey N, Daneman D: Continuous glucose monitoring in adolescents with cystic fibrosis. J Pediatr 2005;147:396–398.
  22. Beardsall K, Ogilvy-Stuart AL, Ahluwalia J, Thompson M, Dunger DB: The continuous glucose monitoring sensor in neonatal intensive care. Arch Dis Child Fetal Neonatal Ed 2005;90:F307–F310.
  23. Kairamkonda V: Does continuous insulin infusion improve glycaemic control and nutrition in hyperglycaemic very low birth weight infants? Arch Dis Child 2006;91:76–79.
  24. Kao LS, Morris BH, Lally KP, Stewart CD, Huseby V, Kennedy KA: Hyperglycemia and morbidity and mortality in extremely low birth weight infants. J Perinatol 2006;26:730–736.
  25. Blanco CL, Baillargeon JG, Morrison RL, Gong AK: Hyperglycemia in extremely low birth weight infants in a predominantly Hispanic population and related morbidities. J Perinatol 2006;26:737–741.
  26. Meetze W, Bowsher R, Compon J, Moorehead H: Hyperglycemia in extremely low-birth-weight infants. Biol Neonate 1998;74:214–221.
  27. Thabet F, Bourgeois J, Guy B, Putet G: Continuous insulin infusion in hyperglycaemic very-low-birth-weight infants receiving parenteral nutrition. Clin Nutr 2003;22:545–547.
  28. Alaedeen DI, Walsh MC, Chwals WJ: Total parenteral nutrition-associated hyperglycemia correlates with prolonged mechanical ventilation and hospital stay in septic infants. J Pediatr Surg 2006;41:239–244.
  29. Garg R, Agthe AG, Donohue PK, Lehmann CU: Hyperglycemia and retinopathy of prematurity in very low birth weight infants. J Perinatol 2003;23:186–194.
  30. Hellstrom A, Carlsson B, Niklasson A, et al: IGF-I is critical for normal vascularization of the human retina. J Clin Endocrinol Metab 2002;87:3413–3416.
  31. Hellström A, Engström E, Hard AL, Albertsson-Wikland K, Carlsson B, Niklasson A, Löfqvist C, Svensson E, Holm S, Ewald U, Holmström G, Smith LEH: Postnatal serum insulin-like growth factor I deficiency is associated with retinopathy of prematurity and other complications of premature birth. Pediatrics 2003;112:1016–1020.
  32. Goya L, de la Puente A, Ramos S, Martín MA, Escrivá F, Álvarez C, Pascual-Leone AM: Regulation of IGF-I and -II by insulin in primary cultures of fetal rat hepatocytes. Endocrinology 2001;142:5089–5096.


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