Abstract
BackgroundContinuous glucose monitoring using subcutaneous sensors is useful in the management of glucose control in neonatal intensive care. We evaluated feasibility and reliability of a continuous glucose monitoring system in a population of very low birth weight neonates needing parenteral nutrition. Moreover, we presented percentiles of glycemia of the studied population.MethodsVery low birth weight neonates were enrolled within 24 h from birth. An ENLITE sensor connected to a continuous glucose monitoring system was inserted and maintained for at least 72 h. Data obtained with the continuous glucose monitoring system and with a glucometer were compared. Calibration was performed every 12 h.ResultsTwenty-three patients (9 males) were included. Median gestational age was 28 weeks (range 23–30) and median birth weight was 860 g (range 500–1092). A total of 299 paired glucose values were obtained. Modified Clarke Error Grid criteria for clinical significance were met. 74 and 33 episodes of hypoglycemia and hyperglycemia were detected, respectively. 31,329 values of glycemia were analyzed and the percentiles calculated.ConclusionsThis continuous glucose monitoring system is safe and accurate. It allows increasing the detection of hypo- and hyper-glycaemia episodes and it could be routinely used in the management of glucose infusion in very low birth weight neonates under total parenteral nutrition.
Highlights
Continuous glucose monitoring using subcutaneous sensors is useful in the management of glucose control in neonatal intensive care
Very low birth weight (VLBW) neonates fed by parenteral nutrition were included in this study, with the aim of testing the reliability of the Medtronic’s CGM system (CGMS) in this specific new setting
The criteria used in our unit to start parenteral nutrition, based on ESPGHAN, ESPEN and ESPR guidelines [17,18,19], were applied: Birth Weight (BW) ≤1250 g; 1250 g ≤ BW ≥ 1500 g associated with severe RDS or being small for gestational age with a documented prenatal history of severe placental insufficiency (umbilical doppler sonography assessing absent end diastolic (AED) or absent/reverse end diastolic (ARED) flow or brain sparing)
Summary
Continuous glucose monitoring using subcutaneous sensors is useful in the management of glucose control in neonatal intensive care. Some authors expressed concerns about using CGM in the clinical setting [15] They showed that the calibration methods of new generations CGM sensors are designed for higher glucose concentrations of children and adults, and not for neonates. VLBW neonates fed by parenteral nutrition were included in this study, with the aim of testing the reliability of the Medtronic’s CGMS in this specific new setting. We aimed at describing the distribution of glycemic values in the studied population Such data is currently lacking in the scientific literature [16] for VLBW infant requiring parenteral nutrition, but it could be very useful to allow a proper modulation of the glucose infusion, preventing dysglycemic episodes, to reduce and optimize the need of insulin therapy, and hopefully to lead to the definition of a new protocol for a strict glycemic control in randomized controlled trials
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