Abstract
BackgroundPoint of care (POC) glucose meters are routinely used as a screening tool for hypoglycemia in a neonatal setting. Glucose meters however, lack the same accuracy as laboratory instruments for glucose measurement. In this study we investigated potential reasons for this inaccuracy and established a cut off value for confirmatory testing.MethodsIn this prospective study, all patients in the neonatal intensive care unit who had a plasma glucose test ordered were eligible to participate. Demographic information, sample collection information (nine variables) and a recent hematocrit value were recorded for each sample. Glucose measurements were taken at the bedside on the glucose meter (RN PCx) as well as in the laboratory on both the glucose meter (LAB PCx) and the laboratory analyzer (PG). Data were analyzed by simple and mixed-effects regression analysis and by analysis of a receiver operator characteristics (ROC) curve.ResultsThere were 475 samples analyzed from 132 patients. RN PCx values were higher than PG values (mean = 4.9%), while LAB PCx results were lower (mean = -5.2%) than PG values. Only 31% of the difference between RN PCx – PG and 46% of the difference for LAB PCx – PG could be accounted for by the variables tested. The largest proportion of variance between PCx and PG measurements was explained by hematocrit (about 30%) with a greater effect seen at glucose concentrations ≤4.0 mmol/L (≤72 mg/dL)(48% and 40% for RN PCx and LAB PCx, respectively). The ROC analysis showed that for detection of all cases of hypoglycemia (PG < 2.6 mmol/L)(PG < 47 mg/dL) the PCx screening cut off value would need to be set at 3.8 mmol/L (68 mg/dL) requiring 20% of all samples to have confirmatory analysis by the laboratory method.ConclusionThe large difference between glucose results obtained by PCx glucose meter compared to the laboratory analyzer can be explained in part by hematocrit and low glucose concentration. These results emphasize that the glucose meter is useful only as a screening device for neonatal hypoglycemia and that a screening cut off value must be established.
Highlights
Point of care (POC) glucose meters are routinely used as a screening tool for hypoglycemia in a neonatal setting
A portion was used for testing glucose at the bedside by a registered nurse using the Precision PCx glucose meter (RN PCx) (Abbott Laboratories, Medisense Products, Bedford, MA) and the remaining sample was sent by a pneumatic tube system to the laboratory for testing by a registered technologist on both the Precision PCx glucose meter (LAB PCx) and the laboratory analyzer (PG) (Vitros 950, Ortho-Clinical Diagnostics, Rochester, NY)
Data missing in other categories ranged from 0.4 to 2.7% except for the time between RN PCx and LAB PCx measurements (5.7%)
Summary
Point of care (POC) glucose meters are routinely used as a screening tool for hypoglycemia in a neonatal setting. Adaptation to the extra-uterine environment requires the newborn to establish glucose regulation and this transition usually takes place smoothly. Some infants such as those that are small or large for gestational age, discordant twins, those with insulin dependent diabetic mothers, or low or extremely low birth weight infants may be at risk for neonatal hypoglycemia [1]. In these patients glucose measurements are usually monitored at the bedside using point of care (POC) glucose meters. While the definition of clinically significant neonatal hypoglycemia is itself controversial and may vary depending on the clinical circumstance [3,4] maintaining therapeutic plasma glucose levels at 2.6 mmol/L or higher is considered desirable [3]
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