Fellow University of Minnesota Masonic Children's Hospital Saint Paul, Minnesota, United States
Background: Preterm infants are at high risk for glucose instability, particularly during the first two weeks of life. Both hypoglycemia and hyperglycemia have been shown to impact long term neurodevelopmental outcomes and growth in this vulnerable population. Although continuous glucose monitoring (CGM) is widely used in older children and adults, it is not approved for use in preterm infants and experience in this population is limited. Objective: Determine feasibility of CGM in extremely preterm infants during the first two weeks of life and describe glycemic characteristics during this period. Design/Methods: Prospective observational cohort study of infants with gestational age (GA) at birth < 31 weeks, admitted to the University of Minnesota Masonic Children’s Hospital NICU were enrolled. A Dexcom G6 sensor was placed on the upper thigh by a trained nurse or physician within 24 hours of consent, no later than 96 hours of life. The device was unblinded with a low alarm set at 60 mg/dL in infants not receiving insulin and at 80 mg/dL in infants receiving insulin. The decision to draw a blood glucose level at the time of a low or high CGM alarm was at the clinical discretion of the medical care team. Otherwise, serum glucose levels were assessed per unit protocol. The infants were treated for hypo- or hyperglycemia according to the NICU protocol based on bedside or central lab serum glucose levels. The device was worn for 10 days, and, if necessary, was replaced one time. Skin assessments were performed at least daily and after the removal of the device. Descriptive statistics were used to summarize patient demographics and CGM measures. Results: Infants (Birth GA = 27.5 +/-2.3 weeks; n=13) wore the CGM device for an average of 9.5 days (range 8-10). The mean glucose for the cohort was 160.7 +/- 37.7 mg/dL . The percent of time spent < 50 mg/dL was 0.0% (0.0-0.3), < 70 mg/dL was 0.8% (0-3.2), between 70-180 mg/dL was 68.1% (13.1-99.2), between 181-250 mg/dL was 23.7% (0.3-73.0), and > 250 mg/dL was 7.4% (0.0-33.1). No adverse events related to the device were observed.
Conclusion(s): CGM is feasible and well-tolerated in preterm infants.While the majority of time was spent in an euglycemic state, there was a significant amount of time (~30% overall) spent hyperglycemic (>180 mg/dL). Hypoglycemia was rare in this population. This study is continuing to enroll and will describe the glycemic patterns of very preterm infants and the potential relationship of hyperglycemia to long-term growth and neurodevelopmental outcomes.
