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Use of Continuous Glucose Monitoring in Neonates

Mahdi Alsaleem1*, Fadi J AlMuhaisen2, Lina Saadeh3

1Department of Pediatrics, University at Bufallo

2Department of Pediatric Endocrinology, Kansas University

3Department of Pediatric Endocrinology, University at Buffalo

Corresponding Author: Mahdi Alsaleem, Department of Pediatrics, University at Buffalo, United States.Email id: dmahdialsaleem@hotmail.com

Received: May 16, 2019; Published: June 05, 2019

Abstract

Neonatal hypoglycemia remains one of the most common controversial topics in the field of neonatology. Use of Continues glucose monitoring (CGM) in the adult population is well established. In this review, we present the recent updates about the use of CGM devices in both preterm and term neonates.

Keywords: Hypoglycemia, CGM, Neonates, Glucose

Abbreviations CGM: Continuous Glucose Monitoring; BG: Blood Glucose; MARD: Mean Absolute Relative Difference; IVH: Intraventricular Hemorrhage

Use of Continuous Glucose Monitoring in Neonates

Glucose monitoring is an essential part of the management of glucose-related diseases such as diabetes and neonatal hypogly-cemia. Throughout the time (figure 1), there has accelerated technological advancement of CGM devices and techniques, to provide more accurate, quality of life supportive management for lifelong disease, to help guide the clinicians as well patients in the management of the related disorders [1]. Continuous glucose monitoring CGM device can be used to follow glucoselevels twentyfour hours [2].The sensor measures interstitial glucose level. These devices typically consist of three parts: A temporary needle sensormeasures the interstitialglucoselevelsconnected to a transmitter by the different interface based on the manufacture, and a receiver that record the data received by the sensor [3]. The use of CGM devices has the advantages of having real-time data about the body reaction to insulin, food, and other factors[4]. Also, it allows the chance to monitor blood glucose (BG) levels during less convenient times for patients (Overnight, prolonged exercise, fasting, and others) [5,6].Advancement in technology and research continuetoimprove the accuracy, feasibility, and availability of thesedevices for diabetic patients [7-9].The accuracy of CGM isbeing measured by the mean absolute relativedifference(MARD), which is the mean of the absolute differencesbetwe-en CGM and simultaneous reference values as a percentage of the reference value. Errors of ≤13% are generallyconsideredacceptable [10].

Although the rule of CGM is well established in thecare process for diabetes mellitus, its’ rule in neonatal glucose monitoring is less clear. Driven by the high incidence of neonatal hypoglycemia and the associated adverse neuro-developmental outcomes associated with it [11-13],multiple recent studies have looked into the use of CGM in newborns and preterm neonates. The challenge with the use of CGM devices inneonates arises from the relatively small size, limited subcutaneous fat, and the unclear understanding of the normal glucose hemostasis in neonates. Beardsall et al. [14]showed in their cohort of very low birth weight infants that the use of CGM devices in very low birth weight infants was safe and practical with very good correlation with the routine blood glucose measurements. This finding was later confirmed in more recent studies for the same populations [15-17].More recent technological advances in CGM unlinkedsensors target-ing preterm population resulted in more convenient nursing care and was associated with less procedural pain when com-pared to the regular blood glucose measurements methods [18,19].Use of CGM was also studied in infants at risk for hypoglycemia; Harris, Deborah L, et al. [20]followed 102 infants ≥ 32 weeks glucose levels with CGM devices, in themeantime in those infants, intermittentbloodglucosemeasure-ment using glucose oxidase test was performed. Theyfound that the CGM use resulted in significantly more episodesof hypoglycemia about 81% that were not detected by regular BG measurements. Another small sample study looked at thefeasi-bility of using CGM in term and near-term infants born tomother with diabetes [21],The authors concluded that the use of CGM is beneficial early after birth in this subset of infants.

Use of CGM to Predict Short and Long-termNeuro-developmental Outcomes

As the operational threshold and the BG levels that require interventions or result in adverse neurodevelopmentaloutcome-remains one of the most controversial questions in the field of the neonatology. Attempts have been made to use CGM data to compare longterm outcomes,McKinlay et al.[22]in largesample studyevaluated the neurological outcomes at two years of age between the infant with low BG< 47 mg/dl whoreceivedtreat-ment and those who had similar levelsdetected by the CGM, but didn’t receive treatment. No difference was found between the two groups regarding neurosensory impairment and processing difficulties. The authorsconcluded with the assist of themasked data obtained by the CGM that low BG levels<47werenot associated with adverseneurodevelopmental outcomes. Another small sample study to evaluate the short-term adverse outcomes suggested that the use of CGM can help detect IVH, as suggested by the glucose variability captured early by theuse of CGM devices [23].

Figure

Figure 1: Timeline of glucose monitoring, FDA: Food and Drug Administration; CGM: Continuos Glucose Mounitoring.

Conclusion

CGM sensor use in term and preterm neonates is practical, safe and feasible. It does provide the advantages of real-time data, as well as decrease the babies discomfort by decreasing the frequency of blood sampling. Data without interventionobtain-ed by CGM didn’t show significant adverse outcomes as a result of neonatal hypoglycemia. Future research is needed to evaluate long term outcomes based on the interventions made according to the data obtained by CGM before adopting this new technology.

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