Stanley Charles A, Weston Philip J, Harris Deborah L, De León Diva D, Harding Jane E
Congenital Hyperinsulinism Center, Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Arch Dis Child Fetal Neonatal Ed. 2024 Oct 18;109(6):580-585. doi: 10.1136/archdischild-2024-326865.
The Glucose in Well Babies (GLOW) Study showed that there are two phases of low glucose concentrations in healthy newborn infants: an initial phase in which plasma concentrations of ketones are low; and a second phase in which low glucose concentrations are accompanied by elevated concentrations of ketones. The implications of these two phases for the brain differ depending on whether ketones are available as alternative substrate for brain metabolism. The purpose of this study was to estimate the duration of these two phases of neonatal low glucose concentrations in 66 healthy breastfed newborns from the GLOW Study during the first 5 days of life.
The sum of glucose and beta-hydroxybutyrate (BOHB) was used as a proxy for the total concentrations of insulin-dependent fuels for the brain; a threshold value below 4 mmol/L was taken to indicate the presence of relative hyperinsulinism and a BOHB concentration above 0.5 mmol/L to indicate ketonaemia.
The first phase of low glucose concentrations lasted a median of 40 hours and in 15% of infants, this persisted beyond 60 hours. Fifty (76%) of the 66 infants subsequently had ketonaemia, which resolved at a median age of 76 hours (range 41->120 hours).
These data suggest that monitoring BOHB concentrations may be useful for interpreting glucose concentrations in newborns and screening for persistent hyperinsulinism.
健康婴儿血糖（GLOW）研究表明，健康新生儿存在两个低血糖浓度阶段：第一阶段血浆酮浓度较低；第二阶段低血糖浓度伴随着酮浓度升高。这两个阶段对大脑的影响因酮是否可作为大脑代谢的替代底物而有所不同。本研究的目的是估计来自GLOW研究的66名健康母乳喂养新生儿在出生后前5天内这两个新生儿低血糖浓度阶段的持续时间。
葡萄糖和β-羟基丁酸（BOHB）的总和用作大脑胰岛素依赖性燃料总浓度的替代指标；低于4 mmol/L的阈值被视为存在相对高胰岛素血症，BOHB浓度高于0.5 mmol/L被视为酮血症。
低血糖浓度的第一阶段持续时间中位数为40小时，15%的婴儿该阶段持续超过60小时。66名婴儿中有50名（76%）随后出现酮血症，酮血症在中位年龄76小时（范围41->120小时）时消退。
这些数据表明，监测BOHB浓度可能有助于解释新生儿的血糖浓度并筛查持续性高胰岛素血症。
