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Agreement between intermittent glucose concentrations and continuous glucose monitoring in at-risk newborns

Journal of Perinatology (2024)Cite this article

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Neonatal hypoglycemia (NH) is the most common metabolic disturbance affecting newborns, and has been linked with poor academic performance [1]. Many knowledge gaps persist regarding its definition, long-term impact, screening and management, and proper measurement and monitoring of glucose concentrations [2].

Current hypoglycemia screening involves intermittent glucose measurement using point-of-care (POC) glucometers. Samples are obtained every few hours per NH screening protocols. Additional painful needle sticks are performed for (1) laboratory confirmation of low POC values, (2) serial pre-prandial testing, and (3) placement of intravenous catheters for parenteral treatment of NH. Continuous glucose monitoring (CGM), in contrast, holds promise as a less painful method of evaluating glucose concentrations continuously in order to identify dysglycemia and improve family-centered care and parental satisfaction. It requires only one needle stick during CGM sensor placement and reports interstitial glucose concentrations every 5 min. Repeated and prolonged hypoglycemia as well as glycemic instability are associated with adverse neurological outcomes; [2] these episodes cannot be fully evaluated with current intermittent POC technology. Thus, CGM has the potential for increased detection of these potentially harmful episodes, which will enable timely treatment. The single center REACT feasibility pilot trial evaluating the use of CGM in very preterm infants reported low bias (−4.9 mg/dL, 95% CI −6.3 to −3.4 mg/dL, n = 20) when the CGM was calibrated every 12 h [3, 4]. An agreement study of glucose concentrations between CGM (that does not require calibration) and intermittent values in at-risk late preterm and term newborns, who represent the majority of newborns with hypoglycemia, however, is lacking. Thus, our pilot study aimed to assess the accuracy of CGM in at-risk newborns.

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References

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Acknowledgements

This work was supported by the Gerber Foundation and the Children’s Miracle Network.

Funding

This study was primarily funded by the Gerber Foundation. Dexcom provided an investigator-initiated research grant to provide Dexcom sensors and supplies. Children’s Miracle Network provided a grant for start-up funds.

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Authors and Affiliations

  1. Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    N. S. Patel

  2. Division of Neonatology, Department of Pediatrics, Lehigh Valley Reilly Children’s Hospital, Allentown, PA, USA

    R. P. Duke

  3. Division of Biostatistics and Bioinformatics, Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA

    Z. Tian & S. Zhou

  4. Division of Neonatal-Perinatal Medicine, Departments of Pediatrics and Obstetrics & Gynecology, Penn State Health Children’s Hospital, Hershey, PA, USA

    J. R. Kaiser

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  1. N. S. Patel
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  2. R. P. Duke
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  3. Z. Tian
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  4. S. Zhou
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  5. J. R. Kaiser
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Contributions

NP conceptualized and designed the study, analyzed data, interpreted results, and drafted the manuscript. RD assisted in conceptualizing and designing the study. ZT and SZ analyzed data and provided statistical support. JK made contributions to analyzing the data, interpreting the results, and revising the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

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Correspondence to N. S. Patel.

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Patel, N.S., Duke, R.P., Tian, Z. et al. Agreement between intermittent glucose concentrations and continuous glucose monitoring in at-risk newborns. J Perinatol (2024). https://doi.org/10.1038/s41372-024-01906-6

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  • DOI: https://doi.org/10.1038/s41372-024-01906-6

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