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Continuous Glucose Monitoring in the Management of Neonates With Persistent Hypoglycemia and Congenital
Myat Win1, Rowan Beckett2, Lynn Thomson3
1Department of Paediatrics, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK.
Insights
Continuous glucose monitoring (CGM) in newborns with persistent hypoglycemia revealed significant glucose fluctuations, especially in congenital hyperinsulinism cases. This technology aids in managing neonatal hypoglycemia and improving neurodevelopmental outcomes.
Area of Science:
- Neonatology
- Endocrinology
- Medical Devices
Background:
- Persistent hypoglycemia in newborns is common and linked to poor neurodevelopmental outcomes.
- Current monitoring relies on frequent blood sampling, which is invasive and burdensome.
- Continuous glucose monitoring (CGM) use in neonatology is limited but holds potential.
Purpose of the Study:
- To introduce real-time CGM for insights into neonatal dysglycemia patterns.
- To evaluate CGM's utility in managing persistent neonatal hypoglycemia.
Main Methods:
- A single-center retrospective study involving real-time CGM.
- CGM data collected over 4 years in 14 infants with persistent hypoglycemia.
- Analysis of glucose variability and comparison with blood glucose values.
Main Results:
- CGM demonstrated marked glucose fluctuations in infants with congenital hyperinsulinism (CHI).
- Higher glucose variability (SD) observed in CHI infants compared to preterm infants.
- CGM showed an 11% mean absolute relative difference compared to blood glucose measurements.
Conclusions:
- CGM highlights challenges in preventing hypoglycemia with intermittent blood glucose monitoring alone.
- Real-time CGM shows potential as an adjunct tool for clinical management of neonatal hypoglycemia.
Background:
Persistent hypoglycemia is common in the newborn and is associated with poor neurodevelopmental outcome. Adequate monitoring is critical in prevention, but is dependent on frequent, often hourly blood sampling. Continuous glucose monitoring (CGM) is increasingly being used in children with type 1 diabetes mellitus, but use in neonatology remains limited. We aimed to introduce real-time CGM to provide insights into patterns of dysglycemia and to support the management of persistent neonatal hypoglycemia.
Methods:
This is a single-center retrospective study of real-time CGM use over a 4-year period in babies with persistent hypoglycemia.
Results:
CGMs were inserted in 14 babies: 8 term and 6 preterm infants, 9 with evidence of congenital hyperinsulinism (CHI). A total of 224 days of data was collected demonstrating marked fluctuations in glucose levels in babies with CHI, with a higher sensor glucose SD (1.52 ± 0.79 mmol/L vs 0.77 ± 0.22 mmol/L) in infants with CHI compared with preterm infants. A total of 1254 paired glucose values (CGM and blood) were compared and gave a mean absolute relative difference of 11%.
Conclusion:
CGM highlighted the challenges of preventing hypoglycemia in these babies when using intermittent blood glucose levels alone, and the potential application of CGM as an adjunct to clinical care.
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