Continuous Glucose Monitoring in Infants of Very Low Birth Weight

Abstract

Objectives: To evaluate the feasibility and efficacy of a continuous glucose monitoring system (CGMS) in a population of infants of very low birth weight (VLBW). Study Design: Infants weighing ≤1,500 g and of ≤32 weeks of gestation were recruited within 24 h of delivery. A subcutaneous sensor connected to a CGMS was inserted and maintained for 7 days or until dysfunction. Therapeutic management followed the usual standard protocols. Results: 38 patients (21 male) were included over 17 months. Their mean gestational age was 27.5 ± 2.0 weeks and their mean birth weight was 958.3 ± 205.5 g. Their perinatal histories and complications during admission were unremarkable for extremely premature babies. Continuous monitoring lasted an average of 7.84 ± 1.99 days per patient. Hyperglycaemia was detected in 22 (57.90%) patients and it lasted a mean of 20.33 ± 30.13 h, while 14 (36.8%) presented with hypoglycaemia for a mean of 2.45 ± 2.3 h. Conclusions: The CGMS gave a safe and useful estimate of glucose levels in VLBW infants, revealing abnormal glucose levels at a much higher rate than expected by usual sampling. However, it was not able to provide real-time glucose concentration data. CGMS may be very useful in providing information on the role of hyper- and hypoglycaemia on short- and long-term outcomes in VLBW infants.

Contribution of early glycemic status in the development of severe retinopathy of prematurity in a cohort of ELBW infants

“…Although, severity of illness may contribute to glucose instability in ELBW infants, after logistic regression only >30 days TWGL and infection, mainly gram-positive sepsis, are independent predictors of severe ROP. Using continuous glucose monitoring, Iglesias Platas et al 21 have demonstrated that up to 60 and 50% of VLBW infants develop glucose levels X150 and p50 mg dl À1 , respectively; in our population of ELBW infants, the numbers were higher at 79 and 70%, respectively, perhaps reflecting the greater immaturity of our cohort. We have previously shown that average glucose levels are greater in ELBW infants developing ROP stage 3 or 4 with a risk that doubles for every 10 mg dl À1 increase in mean glucose levels.…”

“…To bypass this limitation, we apply a TWGL as a proxy for continuous glucose monitoring. 21,33 A limitation of this approach is the need for as many data points as possible to increase accuracy and to refine the area under the curve. In this study, we analyzed a total of 51 171 glucose data points; of those two-thirds were bedside whole-blood glucose measurements.…”

Preterm Glycosuria – New Data from a Continuous Glucose Monitoring System

“…Using the intermittent sampling method, the incidence of hyperglycemia in preterm infants is estimated to be 25–75% [11, 12]. It is believed that even 50% of glucose abnormalities may escape discrete measurements [13]. Only a few studies analyzed data obtained from CGM systems to date, and both safety and accuracy of the CGM system were validated in VLBW neonates [6, 7, 13].…”

“…It is believed that even 50% of glucose abnormalities may escape discrete measurements [13]. Only a few studies analyzed data obtained from CGM systems to date, and both safety and accuracy of the CGM system were validated in VLBW neonates [6, 7, 13]. …”

Impact of Retrospective Calibration Algorithms on Hypoglycemia Detection in Newborn Infants Using Continuous Glucose Monitoring

“…[16][17][18] However, CGM devices have also been used to evaluate aspects of glucose metabolism in at-risk newborn infants. 4,[19][20][21][22] In the case of Harris et al, 4 laboratory determinations of BG concentrations were available for the dataset and are assumed to be a ''gold-standard'' assessment. Alternative calibration algorithms can be applied to the CGM readings, using the high accuracy BG measurements, and compared with the factory-calibrated CGM readings.…”