Glycemic variability in preterm infants receiving intermittent gastric tube feeding: Report of three cases

Abstract

Late-onset hypoglycemia (day 12-16, blood glucose <50 mg/dL) was detected in three preterm infants (birthweight 998-1780 g; gestational age 27-30 weeks) by routine screening. All infants showed high serum insulin levels and extremely low ketone levels at the time of hypoglycemia. Continuous glucose monitoring was conducted at 31-34 weeks' postconceptual age when the infants were receiving intermittent gastric tube feeding with no intravenous glucose infusion. The continuous glucose monitoring results showed characteristic postprandial glucose increases and subsequent sharp deceases along with many hyper- and hypoglycemic events. This fluctuating pattern disappeared at 38-40 weeks' postconceptual age. These observations suggest that prolonged insulin oversecretion may be associated with early aggressive intravenous nutrition, and that large glycemic variability is a common feature of tube-fed preterm infants that can be explained by immature glucose homeostasis.

Safety and accuracy of neonatal continuous glucose monitoring

“…There are existing reports of continuous glucose monitoring devices used for neonates. In Japan, only a few cases have been reported, for tube‐fed, very low birthweight infants and for hyperinsulinemic hypoglycemia 6–8 …”

“…In Japan, only a few cases have been reported, for tube-fed, very low birthweight infants and for hyperinsulinemic hypoglycemia. [6][7][8] We first examined the safety and accuracy of the FGM device in term neonates before using it in high-risk infants who need careful blood glucose management.…”

Intraday glucose fluctuation is common in preterm infants receiving intermittent tube feeding

“…In contrast, continuous feeding may reduce feeding intolerance and improve growth . We previously suggested that continuous feeding may also be beneficial from the perspective of glycemic stability . The clinical significance of large glycemic variability regarding future complications of preterm infants, however, remains to be determined.…”

“…Recently, we described the cases of preterm infants who had repeated abnormal glucose levels >3 weeks after birth, detected on continuous glucose monitoring (CGM). 1 CGM was initially developed to improve the metabolic control in diabetes mellitus. CGM is also useful, safe, and reliable in neonates, including infants with very low birthweight.…”