Neonatal - Perinatal Medicine Fellow Texas Children's Hospital / Baylor College of Medicine. Houston, Texas, United States
Background: Neonatal hypoglycemia is often asymptomatic, resulting in a poor prognosis, and a higher risk of long-term neurocognitive impairments. When untreated, persistent neonatal hypoglycemia can become clinically apparent as tremors, apnea, tachypnea, hypothermia, hypotonia, inability to feed, lethargy, or seizures, and may result in permanent brain damage, or in severe cases, death. Early and accurate detection of neonatal hypoglycemia is critical to treatment and prevention of complications. Serum and/or plasma methods is the current reference standard for measuring glucose levels. This requires repeated blood sampling, which is painful, costly, and time consuming, but point-of-care (POC) glucose measurement is a more rapid, cost-effective, and less traumatic method of measuring glucose levels in newborns. The accuracy of POC glucose measurements compared to serum/plasma lab measurements has not been systematically reviewed in neonates. A clear understanding of the diagnostic accuracy of POC glucose measurements in neonates is important to inform clinical practice. Objective: To determine the diagnostic accuracy of POC glucose measurement compared to laboratory measurements for measuring glucose concentrations in neonates. Design/Methods: We reviewed retrospective cross-sectional studies, cohort studies, and randomized control trials comparing POC and serum/plasma glucose measurement for hypoglycemia in preterm and term newborns aged 0 to 29 days between January 1, 2013 and September 30, 2023. We used a standard search strategy of the Cochrane Neonatal Review Group to identify all relevant studies without any language restriction. We included studies conducted in the neonatal intensive care units, newborn nurseries, and labor and delivery units. We excluded case reports. Results: Twenty-seven studies conducted in 12 different countries met our inclusion criteria, the majority (82%) of which utilized a prospective study design. A total of 7,027 neonates were analyzed in these studies with an average (range) study sample size of 270 infants (24–1100). The most common hypoglycemia level used was < 45 mg/dl (median: 47, range 38-76 mg/dl). Among studies reporting performance metrics for the POC comparator in identifying hypoglycemia, the mean (range) sensitivity=82.7% (41.8%-100%), specificity=80.2% (45.5%-99.2%), positive predictive value=80.1% (59.5%-95.0%) and negative predictive value=82.7% (69.7%-99.6%).
Conclusion(s): POC testing accuracy in predicting hypoglycemia varied greatly across the studies included in this review indicating that POC results in neonates should be interpreted with caution.
