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Review
. 2017 Oct 17:3:18.
doi: 10.1186/s40748-017-0055-z. eCollection 2017.

Continuous glucose monitoring in neonates: a review

Christopher J D McKinlay  1   2 , J Geoffrey Chase  3 , Jennifer Dickson  3 , Deborah L Harris  1   4 , Jane M Alsweiler  1   2 , Jane E Harding  1
Affiliations
Review

Continuous glucose monitoring in neonates: a review

Christopher J D McKinlay et al. Matern Health Neonatol Perinatol. .

Abstract

Continuous glucose monitoring (CGM) is well established in the management of diabetes mellitus, but its role in neonatal glycaemic control is less clear. CGM has provided important insights about neonatal glucose metabolism, and there is increasing interest in its clinical use, particularly in preterm neonates and in those in whom glucose control is difficult. Neonatal glucose instability, including hypoglycaemia and hyperglycaemia, has been associated with poorer neurodevelopment, and CGM offers the possibility of adjusting treatment in real time to account for individual metabolic requirements while reducing the number of blood tests required, potentially improving long-term outcomes. However, current devices are optimised for use at relatively high glucose concentrations, and several technical issues need to be resolved before real-time CGM can be recommended for routine neonatal care. These include: 1) limited point accuracy, especially at low or rapidly changing glucose concentrations; 2) calibration methods that are designed for higher glucose concentrations of children and adults, and not for neonates; 3) sensor drift, which is under-recognised; and 4) the need for dynamic and integrated metrics that can be related to long-term neurodevelopmental outcomes. CGM remains an important tool for retrospective investigation of neonatal glycaemia and the effect of different treatments on glucose metabolism. However, at present CGM should be limited to research studies, and should only be introduced into routine clinical care once benefit is demonstrated in randomised trials.

Keywords: Continuous glucose monitoring; Hyperinsulinaemia; Interstitial glucose; Neonatal hyperglycaemia; Neonatal hypoglycaemia.

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Not applicable; review of published data.

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Not applicable.

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The authors declare that they have no competing interests.

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Figures

Fig. 1
Fig. 1
Insertion of a continuous glucose sensor and attachment of transmitter in the lateral thigh of a newborn infant
Fig. 2
Fig. 2
Comparison of the types of measurement error for point-of-care (POC) and continuous glucose monitors (CGM), where CGMs can be prone to drift as well as a zero-centred noise
Fig. 3
Fig. 3
Example of neonatal subcutaneous continuous glucose monitoring (CGM) with retrospective point-to-point calibration (Data from McKinlay et al. [3])
See this image and copyright information in PMC

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