Kalogeropoulou Maria-Sofia, Thomson Lynn, Beardsall Kathryn
School of Clinical Medicine, University of Cambridge, Cambridge, UK.
Paediatrics, Cambridge University, Cambridge, UK.
Arch Dis Child Fetal Neonatal Ed. 2023 May;108(3):309-315. doi: 10.1136/archdischild-2022-324593. Epub 2022 Dec 20.
Glucose dysregulation is common in infants with hypoxic ischaemic encephalopathy (HIE) and is likely to exacerbate cerebral injury. Infrequent measurement of glucose concentrations makes both identification and prevention of this risk challenging. Continuous glucose monitoring (CGM) has the potential to address both these challenges, but has not been explored in these infants. We aimed to evaluate the feasibility and potential impact of real-time CGM in term infants with HIE being treated with therapeutic hypothermia (TH).
Feasibility study.
Tertiary-level neonatal unit, UK.
Term infants with HIE undergoing TH.
A CGM sensor was inserted within 48 hours of birth and kept in situ for the first week of life. Clinical staff were blinded to the CGM recordings and clinical decisions were based on blood glucose assays.
(1) Accuracy of CGM values during and post TH, (2) Per cent of time spent outside the clinical range (2.6-10 mmol/L), (3) Episodes of hypoglycaemia and hyperglycaemia, (4) Adverse effects.
The accuracy of CGM values during TH were comparable to those when infants were normothermic. There was wide variation in per cent time outside the target range (2.6-10 mmol/L) between infants (median 5%, range 0%-34%). CGM identified 44% of infants with ≥1 episode of hypoglycaemia (<2.6 mmol/L) and 50% with ≥1 episode of hyperglycaemia (>10 mmol/L). No adverse events were observed.
This study demonstrates that CGM could be a useful adjunct for glucose monitoring in babies undergoing TH who are at risk of both hypoglycaemia and hyperglycaemia.
葡萄糖调节异常在缺氧缺血性脑病（HIE）婴儿中很常见，且可能会加重脑损伤。由于对葡萄糖浓度的测量不频繁，识别和预防这种风险都具有挑战性。持续葡萄糖监测（CGM）有可能应对这两个挑战，但尚未在这些婴儿中进行研究。我们旨在评估实时CGM在接受治疗性低温（TH）的足月HIE婴儿中的可行性和潜在影响。
可行性研究。
英国三级新生儿病房。
接受TH的足月HIE婴儿。
在出生后48小时内插入CGM传感器，并在出生后的第一周内保持原位。临床工作人员对CGM记录不知情，临床决策基于血糖检测。
（1）TH期间及之后CGM值的准确性，（2）超出临床范围（2.6 - 10 mmol/L）的时间百分比，（3）低血糖和高血糖发作次数，（4）不良反应。
TH期间CGM值的准确性与婴儿体温正常时相当。婴儿之间超出目标范围（2.6 - 10 mmol/L）的时间百分比差异很大（中位数5%，范围0% - 34%）。CGM识别出44%的婴儿有≥1次低血糖发作（<2.6 mmol/L），50%的婴儿有≥1次高血糖发作（>10 mmol/L）。未观察到不良事件。
本研究表明，CGM对于正在接受TH且有低血糖和高血糖风险的婴儿的血糖监测可能是一种有用的辅助手段。
