Lactate, rather than ketones, may provide alternative cerebral fuel in hypoglycaemic newborns

Harris, Deborah L; Weston, Philip J.; Harding, Jane E.

doi:10.1136/archdischild-2014-306435

Cited by 31 publications

(25 citation statements)

References 12 publications

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“…However, the concentrations of ketones are extremely low during the first 48 hours after birth in hypoglycaemic babies, and are unlikely to be neuroprotective at this time 17 .…”

Section: Treatmentmentioning

confidence: 99%

An emerging evidence base for the management of neonatal hypoglycaemia

Harding

Harris

Hegarty

et al. 2017

Early Human Development

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Neonatal hypoglycaemia is common, and screening and treatment of babies considered at risk is widespread, despite there being little reliable evidence upon which to base management decisions. Although there is now evidence about which babies are at greatest risk, the threshold for diagnosis, best approach to treatment and later outcomes all remain uncertain. Recent studies suggest that treatment with dextrose gel is safe and effective and may help support breast feeding. Thresholds for intervention require a wide margin of safety in light of information that babies with glycaemic instability and with low glucose concentrations may be associated with a higher risk of later higher order cognitive and learning problems. Randomised trials are urgently needed to inform optimal thresholds for intervention and appropriate treatment strategies.

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“…However, the concentrations of ketones are extremely low during the first 48 hours after birth in hypoglycaemic babies, and are unlikely to be neuroprotective at this time 17 .…”

Section: Treatmentmentioning

confidence: 99%

An emerging evidence base for the management of neonatal hypoglycaemia

Harding

Harris

Hegarty

et al. 2017

Early Human Development

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“…Cohort characteristics, glycemic management, and neonatal outcomes have been reported previously. 6,9,10 Infants underwent regular measurement of blood glucose concentrations by means of the glucose oxidase method (ABL800 FLEX, Radiometer) for 24 to 48 hours or until there were no ongoing clinical concerns. Masked continuous interstitial glucose monitoring (CGMS Gold, Medtronic MiniMed) was performed as previously described.…”

Section: Methodsmentioning

confidence: 99%

Neonatal Glycemia and Neurodevelopmental Outcomes at 2 Years

McKinlay¹,

Alsweiler²,

Ansell³

et al. 2015

N Engl J Med

296

256

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Background Neonatal hypoglycemia is common and can cause neurologic impairment, but evidence supporting thresholds for intervention is limited. Methods We performed a prospective cohort study involving 528 neonates with a gestational age of at least 35 weeks who were considered to be at risk for hypoglycemia; all were treated to maintain a blood glucose concentration of at least 47 mg per deciliter (2.6 mmol per liter). We intermittently measured blood glucose for up to 7 days. We continuously monitored interstitial glucose concentrations, which were masked to clinical staff. Assessment at 2 years included Bayley Scales of Infant Development III and tests of executive and visual function. Results Of 614 children, 528 were eligible, and 404 (77% of eligible children) were assessed; 216 children (53%) had neonatal hypoglycemia (blood glucose concentration, <47 mg per deciliter). Hypoglycemia, when treated to maintain a blood glucose concentration of at least 47 mg per deciliter, was not associated with an increased risk of the primary outcomes of neurosensory impairment (risk ratio, 0.95; 95% confidence interval [CI], 0.75 to 1.20; P = 0.67) and processing difficulty, defined as an executive-function score or motion coherence threshold that was more than 1.5 SD from the mean (risk ratio, 0.92; 95% CI, 0.56 to 1.51; P = 0.74). Risks were not increased among children with unrecognized hypoglycemia (a low interstitial glucose concentration only). The lowest blood glucose concentration, number of hypoglycemic episodes and events, and negative interstitial increment (area above the interstitial glucose concentration curve and below 47 mg per deciliter) also did not predict the outcome. Conclusions In this cohort, neonatal hypoglycemia was not associated with an adverse neurologic outcome when treatment was provided to maintain a blood glucose concentration of at least 47 mg per deciliter. (Funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and others.)

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“…Besides glucose, the brain of the newborn infant can to some extent also use ketone bodies and lactate as alternative energy sources. However, newborn infants have an initially lower degree of ketogenesis, which results in lower levels of ketone bodies, and lactate can therefore be a more important cerebral fuel in the first 2 days after birth …”

Section: Guidelinesmentioning

confidence: 99%

“…Blood ketone bodies can also be tested, but newborn infants ability is limited to produce ketone bodies as alternative energy sources upon low blood sugar. Moderate lactate levels are probably a more important energy substrate during the first days of life …”

Section: Guidelinesmentioning

confidence: 99%

“…However, newborn infants have an initially lower degree of ketogenesis, which results in lower levels of ketone bodies, and lactate can therefore be a more important cerebral fuel in the first 2 days after birth. 15,16 At birth, a comprehensive metabolic adaption takes place, and the newborn infant needs to produce its own glucose until the feeding starts. The infant will also have to adapt to bolus feeds, after being used to a continuous supply of nutrients through the umbilical cord.…”

Section: Glucose Homeostasis At Birthmentioning

confidence: 99%

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Swedish national guideline for prevention and treatment of neonatal hypoglycaemia in newborn infants with gestational age ≥35 weeks

et al. 2019

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Aim Postnatal hypoglycaemia in newborn infants remains an important clinical problem where prolonged periods of hypoglycaemia are associated with poor neurodevelopmental outcome. The aim was to develop an evidence‐based national guideline with the purpose to optimise prevention, diagnosis and treatment of hypoglycaemia in newborn infants with a gestational age ≥35 + 0 weeks. Methods A PubMed search‐based literature review was used to find actual and applicable evidence for all incorporated recommendations. The GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach was used for grading the evidence of the recommendations. Results Recommendations for the prevention of neonatal hypoglycaemia were extended and updated, focusing on promotion of breastfeeding as one prevention strategy. Oral dextrose gel as a novel supplemental therapy was incorporated in the treatment protocol. A new threshold‐based screening and treatment protocol presented as a flow chart was developed. Conclusion An updated and evidence‐based national guideline for screening and treatment of neonatal hypoglycaemia will support standardised regimes, which may prevent hypoglycaemia and the risk for hypoglycaemia‐related long‐term sequelae.

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Lactate, rather than ketones, may provide alternative cerebral fuel in hypoglycaemic newborns

Abstract: ACTRN12608000623392.

Cited by 31 publications

References 12 publications

An emerging evidence base for the management of neonatal hypoglycaemia

An emerging evidence base for the management of neonatal hypoglycaemia

Neonatal Glycemia and Neurodevelopmental Outcomes at 2 Years

Swedish national guideline for prevention and treatment of neonatal hypoglycaemia in newborn infants with gestational age ≥35 weeks

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