De Rose Domenico Umberto, Perri Alessandro, Maggio Luca, Salvatori Guglielmo, Dotta Andrea, Vento Giovanni, Gallini Francesca
Neonatal Intensive Care Unit, "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy.
Neonatology Unit, Department of Woman and Child Health and Public Health - Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy.
Eur J Pediatr. 2024 Mar;183(3):1113-1119. doi: 10.1007/s00431-023-05405-2. Epub 2024 Jan 5.
Neonatal hypoglycemia is a major source of concern for pediatricians since it has commonly been related to poor neurodevelopmental outcomes. Diagnosis is challenging, considering the different operational thresholds provided by each guideline. Screening of infants at risk plays a crucial role, considering that most hypoglycemic infants show no clinical signs. New opportunities for prevention and treatment are provided by the use of oral dextrose gel. Continuous glucose monitoring systems could be a feasible tool in the next future. Furthermore, there is still limited evidence to underpin the current clinical practice of administering, in case of hypoglycemia, an intravenous "mini-bolus" of 10% dextrose before starting a continuous dextrose infusion. This brief review provides an overview of the latest advances in this field and neurodevelopmental outcomes according to different approaches. Conclusion: To adequately define if a more permissive approach is risk-free for neurodevelopmental outcomes, more research on continuous glucose monitoring and long-term follow-up is still needed. What is Known: • Neonatal hypoglycemia (NH) is a well-known cause of brain injury that could be prevented to avoid neurodevelopmental impairment. • Diagnosis is challenging, considering the different suggested operational thresholds for NH (<36, <40, <45, <47 or <50 mg/dl). What is New: • A 36 mg/dl threshold seems to be not associated with a worse psychomotor development at 18 months of life when compared to the "traditional" threshold (47 mg/dl). • Further studies on long-term neurodevelopmental outcomes are required before suggesting a more permissive management of NH.
新生儿低血糖是儿科医生主要关注的问题，因为它通常与不良的神经发育结局有关。鉴于各指南给出的不同操作阈值，诊断具有挑战性。鉴于大多数低血糖婴儿没有临床症状，对有风险的婴儿进行筛查起着至关重要的作用。口服葡萄糖凝胶的使用为预防和治疗提供了新的机会。连续血糖监测系统在未来可能会成为一种可行的工具。此外，对于在低血糖情况下开始持续葡萄糖输注之前先静脉注射10%葡萄糖“小剂量推注”这一当前临床实践，仍缺乏足够的证据支持。本简要综述概述了该领域的最新进展以及根据不同方法得出的神经发育结局。结论：为充分确定更宽松的方法对神经发育结局是否无风险，仍需要对连续血糖监测和长期随访进行更多研究。已知信息：• 新生儿低血糖（NH）是脑损伤的一个已知原因，可通过预防来避免神经发育损害。• 鉴于NH的不同建议操作阈值（<36、<40、<45、<47或<50mg/dl），诊断具有挑战性。新信息：• 与“传统”阈值（47mg/dl）相比，36mg/dl的阈值似乎与18个月大时较差的精神运动发育无关。• 在建议对NH采取更宽松的管理之前，需要对长期神经发育结局进行进一步研究。
