Hi,

I am managing a child with persistent hypoglycemia. While balancing carbohydrates, feeding etc. there have been a bit to many blood samples for me to be comfortable with. I was reading Gomella (Gomella's Neonatology 8th edition, 2020 pp 588-589) and they mention CGM:s being approved for the use in newborns, although not routinely used in clinical practice. I would like to ask if any of your units have implemented continous glucose monitoring? Which are the indications, at what gestational ages and weights? Which are your experiences with CGM, positive or negative? Are there any limitations?

Best, Gustaf

Hi Gustaf,

We do it not routinely at our wards, but we did it quite recently in an extreme premature infant with a corrected age of 35 weeks. We found it quite helpful and we were able to reduce the blood sampling. We did it together with our pediatric diabetes team. They have a lot of experience with such devices, but not infants. So it was quite tricky for us how to handle low and high alarms, so they wanted always a blood-based control if the sensor showed an alarm in both ways  (I think it was <50 mg/dl and 200 mg/dl) - sometimes this occurred 4-6 times a day. Overall, I think it was positive for the baby since we could reduce the blood draws. However, in some low alarm cases, the sensor and the blood draw results were not comparable (even lower or sometimes higher). 

From my perspective, CGM is an innovative and promising technology that offered us some advantages in this case. Nonetheless, I advocate for a cautious approach towards its routine use in neonatal care, given the limited studies and practical experience in this specific cohort. I am curious to learn if others have integrated CGM into their regular neonatal care practices and would greatly appreciate insights or experiences from those who have.  I would also like to hear some reports!

Best,

Lukas

Hi Gustaf, 

We have used the old Freestyle system a few years ago in I think three preterm and newborns with a weight of 2500 or higher. We did place the sensor on the outer upper leg or buttock above diaper level and inserted the "feeler"? only about half of its length in a pretty flat angle. It worked great. When established, we only take blood for demanded calibration. 

Yours Nele 

Thank you for your feedback. It's really great to hear about how it's been implemented and tried. I believe a challenge could be that you need som subcutaneous fat for it to work properly and that there is a small delay between blood-sugars and interstitium. Better for LGA-babies of diabetic mothers than our SGA hypoglycemias perhaps. 

Hi,Gustaf

We have used continuous glucose monitoring in newborns with hyperinsulinemia,was very successful and convenient,the parents were teached to use it at home

Hi Gustaf,

We have been using the CGM for two years in our unit (Ankara/Turkey). It was attached to the outer lateral surface of the upper leg and worked very well. We had no complications except for minimal local bleeding. It is applied to patients at risk of hypoglycaemia (IUGR, SGA, babies of diabetic mothers, etc.) Our smallest patient weighed 1400 grams. We only took blood samples from the patients 2-3 times a day to calibrate the device. I hope you have also benefited.

I was on Bluesky 🦋 and saw @AllThingsNeonatal share this study validating CGM-use in preterms 29-31 weeks, with an acceptable accuracy.

https://www.jpeds.com/article/S0022-3476(24)00519-5/abstract

For our hyperinsulinism infants, sometimes requiring glucose infusion, diazoxide and extensive carbohydrate enriched feeds, this is a very appealing approach. 

Perri A, Tiberi E, Giordano L, Sbordone A, Patti ML, Iannotta R, Pianini T, Cota F, Maggio L, Vento G. Strict glycaemic control in very low birthweight infants using a continuous glucose monitoring system: a randomised controlled trial. Arch Dis Child Fetal Neonatal Ed. 2022 Jan;107(1):26-31. doi: 10.1136/archdischild-2020-320540. Epub 2021 May 26. PMID: 34039690.

 

On 12/21/2023 at 6:46 AM, Gustaf Lernfelt said:

Thank you for your feedback. It's really great to hear about how it's been implemented and tried. I believe a challenge could be that you need som subcutaneous fat for it to work properly and that there is a small delay between blood-sugars and interstitium. Better for LGA-babies of diabetic mothers than our SGA hypoglycemias perhaps. 

...seems to work also in VLBW, some papers like the above mentioned appeared concerning optimizing glycaemic control with parenteral nutrition .... so also from the UK REACT collaborative