Perioperative continuous glucose monitoring in a preterm infant

Abstract

Surgery in the neonatal period presents challenges, especially in preterm infants weighing <1 kg. Their small size, minimal reserves and physiological immaturity means attention to detail and careful monitoring is critical to avoid cardiovascular instability; maintaining fluid balance and metabolic stability is also problematic due to often limited vascular access and small blood volumes. Developments in technology have meant that cardiovascular parameters such as heart rate, blood pressure and oxygen saturations are all routinely and continuously monitored before and during surgery.We have been exploring the role of continuous glucose monitoring (CGM) for metabolic monitoring and management of glucose control in very preterm infants (24-32 weeks gestation). In this paper, we report on a preterm infant who uniquely underwent surgery while wearing a continuous glucose monitor, blinded to the clinical team. This case highlights the metabolic vulnerability of these babies and a possible role for real-time CGM during surgical procedures.

Should continuous glucose monitoring be used to manage neonates at risk of hypoglycaemia?

“…Figure 3 demonstrates the glucose profile of a preterm neonate undergoing surgery and highlights the potential benefits of CGM in this setting where monitoring can be difficult and changes in rates of fluid infusions can lead to rapid falls in glucose levels putting them at risk of hypoglycaemia ( 26 ). For preterm neonates who are presumed to be stable, tolerating intermittent feeds prior to going home, it has been shown that when monitored with CGM, they demonstrated significant dysglycaemia ( 5 , 27 ).…”