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Glucose concentrations in enterally fed preterm infants

Alejandra Barrero-Castillero1,2,3, Wenyang Mao4, Ann R Stark4,5

  • 1Division of Newborn Medicine, Children's Hospital Boston, Boston, MA, USA. abcastil@bidmc.harvard.edu.

Journal of Perinatology : Official Journal of the California Perinatal Association
|August 8, 2020
PubMed

Insights

Hypoglycemia is common in preterm infants on enteral nutrition. The Pediatric Endocrine Society (PES) guideline increased glucose monitoring, but this may lead to unnecessary interventions in well-appearing infants.

Area of Science:

  • Neonatalogy
  • Pediatric Endocrinology
  • Clinical Nutrition

Background:

  • Neonatal hypoglycemia is a significant concern.
  • Current guidelines aim to maintain target glucose concentrations in preterm infants.
  • The impact of these guidelines on monitoring practices needs evaluation.

Purpose of the Study:

  • To determine the prevalence of glucose concentrations below 70 mg/dL in preterm infants on full enteral nutrition.
  • To assess the effect of the Pediatric Endocrine Society (PES) guideline on glucose monitoring practices.

Main Methods:

  • Retrospective cohort study of 1717 preterm infants.
  • Analysis of glucose concentrations at least 48 hours after parenteral fluid discontinuation.
  • Multivariate analysis to identify factors associated with low glucose levels.

Main Results:

  • 76.6% of glucose measurements were ≥70 mg/dL; 16.2% were 60-69 mg/dL; 5.9% were 50-59 mg/dL; 1.3% were <50 mg/dL.
  • Lower glucose concentrations (<60 mg/dL) were associated with male sex, lower postnatal age, small-for-gestational age, and maternal hypertension.
  • Glucose monitoring increased after the PES guideline implementation.

Conclusions:

  • Glucose concentrations below 70 mg/dL are frequent in preterm infants on enteral nutrition.
  • Increased monitoring post-guideline may lead to interventions without proven long-term benefits for well-appearing infants.
  • Re-evaluation of the PES threshold for this population may be warranted.
Abstract

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