690 - Significant neonatal hypoglycemic episodes missed with intermittent measurements

Publication Number: 690.6938

Sandrine Patenaude, Sainte-Justine Hospital Research Center, Montreal, PQ, Canada; Natacha Paquette, Sainte-Justine Hospital Research Center, Montréal, PQ, Canada; Elana Pinchefsky, CHU Sainte-Justine, Montreal, PQ, Canada; Gregory Lodygensky, University of Montreal, Montreal, PQ, Canada; Anne Gallagher, University of Montreal, Montreal, PQ, Canada

Background: Children born prematurely are more likely to have cognitive, language, or vision deficits than children born full-term. In addition, they are at higher risk of neonatal hypoglycemia and hyperglycemia (incidence>30%). As premature birth, neonatal hypoglycemia is a risk factor for neurodevelopmental and cognitive problems, and risks are greater when episodes are severe, recurrent, and not clinically detected. Likewise, neonatal hyperglycemia is linked to an increase in neurosensory deficits and mortality. Blood glucose measurements can be collected intermittently or continuously (CGM: continuous glucose measurement). Although the intermittent method is the most widely used clinically in hospitals, the use of CGM is gradually gaining interest in newborns.

Objective: To determine if CGM can better detect episodes of neonatal hypoglycemia and neonatal hyperglycemia compared to intermittent method.

Design/Methods: Thirty neonates born prematurely (gestational age between 29 and 35.4 weeks) underwent intermittent glucose measurements and CGM (Guardian 3, MedTronic Canada). CGMs were placed in the lateral thigh within the first 48 hours of life until the 6th day after birth. Episodes of hypoglycemia (≤2.6 mmol/L) and hyperglycemia (≥8.3 mmol/L) were identified for both methods. One episode in the intermittent method corresponds to one abnormal blood glucose measurement while the one episode in the CGM method corresponds to two or more consecutives measurements. The numbers of episodes of neonatal hypoglycemia and hyperglycemia detected by the two methods were then compared using paired T-tests.

Results: A significant difference was found between intermittent and CGM measurements for neonatal hypoglycemia (t =-3.456, p =0.002) and not for neonatal hyperglycemia (t =-1.391, p = 0.180). When all participants were taken together, 119 episodes of neonatal hypoglycemia were detected after the first 48h of life using the CGM. From those, 106 episodes were not detected using intermittent measurements. Similarly, 16 episodes of neonatal hyperglycemia were detected using the CGM but 13 were missed using intermittent measurements.

Conclusion(s): Even after the first 48 hours of life, several episodes of hypoglycemia and hyperglycemia are detected using CGM, whereas they are missed with the intermittent method. This study provides important results contributing to the discussion on the relevance of using CGMs in neonatal intensive care units, particularly in premature babies.