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Continuous glucose monitoring in the neonatal intensive care unit: not quite ready for ‘plug and play’
  1. Teri L Hernandez1,2,
  2. William W Hay Jr3,
  3. Paul Joseph Rozance3
  1. 1 Department of Medicine, Division of Endocrinology, Metabolism, and Diabetes, University of Colorado School of Medicine, Aurora, Colorado, USA
  2. 2 College of Nursing, University of Colorado, Aurora, Colorado, USA
  3. 3 Department of Pediatrics, Perinatal Research Center, University of Colorado School of Medicine, Aurora, Colorado, USA
  1. Correspondence to Paul Joseph Rozance, Department of Pediatrics, Perinatal Research Center, University of Colorado School of Medicine, Aurora, CO 80045, USA; Paul.Rozance{at}ucdenver.edu

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In the very low birthweight (VLBW) infant population, high glucose concentrations have been associated with increased mortality, brain injury, retinopathy of prematurity and worse neurodevelopmental outcomes. However, trials to prevent or treat hyperglycaemia in this population with continuous insulin infusions or a combination of insulin and/or reductions in the glucose infusion rate have been complicated by more frequent episodes of low glucose concentrations. While the long-term significance of these episodes is unknown, most would agree that they should be avoided during treatment of hyperglycaemia with insulin. Emerging data further associate increased glycaemic variability with impaired long-term outcomes. Use of continuous (interstitial) glucose monitoring (CGM) in very preterm, VLBW infants has the potential to minimise the incidence and severity of hypoglycaemia and hyperglycaemia and increase glycaemic stability during critical developmental periods, providing new opportunities to improve long-term neurocognitive outcomes in these children by preventing these common but potentially harmful metabolic disorders.

Thomson et al 1 report the results of a single-centre study in which feasibility of CGM for very preterm infants was assessed. The study was divided into two phases. In the first phase, accuracy was assessed by comparison of real-time (RT) CGM (Paradigm Veo, Medtronic MiniMed) to point-of-care (POC) blood glucose concentrations (Statstrip, Nova Biomedical) in 20 infants. In the second phase, a pilot study was conducted in which 20 infants were randomised to unblinded RT-CGM in conjunction with a clinical guideline dictating care decisions based on the CGM values versus standard neonatal care. In the standard care arm, infant interstitial glucose concentrations were measured with a blinded retrospective recording CGM (iPro2, Medtronic MiniMed) while glucose was managed using the standard of care hospital protocol. The goal of these studies was to generate data to inform a randomised trial evaluating the impact of unblinded RT-CGM in the care …

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