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Updated: Jan 15, 2026
Non-invasive Optical Measurement of Cerebral Metabolism and Hemodynamics in Infants
Published on: March 14, 2013
Cerebral fuels within the first week of life in very preterm infants: a cohort study
Gordon Xin Hua Liu1, Loredana Marcovecchio2,3, K Beardsall4,3
1School of Medicine, University of Auckland-Grafton Campus, Auckland, New Zealand.
Insights
In very preterm infants, ketone levels remained low while lactate levels were initially high and decreased over the first week. Blood glucose and nutritional support did not significantly impact these metabolite concentrations.
Area of Science:
- Neonatal Physiology
- Metabolic Research
- Pediatric Intensive Care
Background:
- Cerebral fuel availability from ketones and lactate is established in term infants, but unclear in very preterm infants.
- A substudy of the REACT trial investigated these fuels in very low birth weight infants.
- The study focused on infants receiving continuous glucose monitoring for glycemic care.
Purpose of the Study:
- To explore ketone and lactate concentrations in the first week of life in very preterm infants.
- To analyze trends in lactate and ketone levels over time.
- To examine relationships between these metabolites, blood glucose, and clinical factors.
Main Methods:
- Prospective collection of ketone and lactate measurements using a point-of-care meter.
- Longitudinal analysis of metabolite concentrations over the first week of life.
- Correlation analysis with blood glucose, demographics, nutritional support, and insulin treatment.
Main Results:
- Lactate concentrations were initially high (1.72 mmol/L on day 2) and decreased over the week (1.19 mmol/L on day 7).
- Ketone concentrations remained consistently low (0.1 mmol/L).
- No consistent relationship was found between blood glucose, macronutrient intake, insulin treatment, and ketone or lactate levels.
Conclusions:
- Very preterm infants exhibit persistently low ketone and relatively high lactate concentrations in the first week of life.
- Further research is needed to understand metabolite changes during hypoglycemia or hyperglycemia.
- Investigating these metabolic shifts over extended neonatal intensive care periods is recommended.
Background:
Ketones and lactate may contribute towards overall cerebral fuel availability in term infants, yet the availability of such cerebral fuels in very preterm infants is unclear. We undertook a prespecified substudy to explore ketone and lactate concentrations in the first week of life in infants recruited to the REACT trial (real-time continuous glucose monitoring in the newborn): an international multicentre randomised controlled trial of 182 very low birth weight infants investigating the use of continuous glucose monitoring in glycaemic care.
Methods:
Ketone and lactate measurements were prospectively collected over the first week of life using the Nova Biomedical point-of-care meter. A longitudinal analysis was undertaken to explore lactate and ketone concentration trends across time and their relationships with blood glucose, baseline demographics, nutritional support and insulin treatment.
Results:
Data were available for 168 infants (85 females) including 2902 blood glucose, 2084 ketone and 2017 lactate samples. The mean (SD) gestational age was 27.4 (2.0) weeks. Lactate concentrations were higher initially, with mean (SD) 1.72 (1.26) mmol/L on day 2 and lowered to 1.19 (1.1) mmol/L on day 7. Ketone concentrations remained consistently low at 0.1 mmol/L. Neither simultaneous blood glucose concentrations, macronutrient intake nor receipt of insulin was consistently related to ketone or lactate concentrations.
Conclusion:
In this cohort of very preterm infants, there were persistently low concentrations of ketones and relatively higher concentrations of lactate throughout the first week of life. Future research should evaluate changes in these metabolites during episodes of acute hypoglycaemia or hyperglycaemia over more prolonged periods of neonatal intensive care.
