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Point-of-care measurements of blood ketones in newborns
  1. Deborah L Harris1,2,
  2. Philip J Weston1,
  3. Jane E Harding2
  1. 1 Newborn Intensive Care Unit, Waikato District Health Board, Hamilton, New Zealand
  2. 2 Liggins Institute, University of Auckland, Auckland, New Zealand
  1. Correspondence to Dr Deborah L Harris, Newborn Intensive Care Unit, Waikato District Health Board, Hamilton 3240, New Zealand; Deborah.Harris{at}


Objective Babies may use alternative cerebral fuels including ketones when blood glucose concentrations are low, but laboratory ketone measurements are slow and expensive. Point-of-care measurement of ketone concentrations, if sufficiently accurate, may provide useful information for clinical care.

Patients and design Eligible babies were 35–42 weeks’ gestation, ≤10 days old and admitted to the newborn intensive care unit. At the time of clinically indicated blood tests, additional samples were taken to measure beta-hydroxybutyrate using a point-of-care analyser and the laboratory method.

Results One-hundred and fifty babies had 142 paired samples. Overall point-of-care accuracy was excellent (mean difference 0.00 mmol/L) and precision was moderate (SD 0.18 mmol/L). A point-of-care measurement ≥0.4 mmol/L was highly predictive of a laboratory measurement ≥0.4 mmol/L (area under the curve 0.98).

Conclusion Point-of-care measurement of blood beta-hydroxybutyrate concentrations is sufficiently accurate in newborns to be potentially useful in clinical care.

Clinical trial registration number Registered with the Australian and New Zealand Clinical Trials Registry ACTRN: 12616000784415. The study was registered before recruitment commenced.

  • beta-hydroxybutyrate
  • hypoglycaemia
  • infant feeding

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  • Contributors DLH designed the study, contributed to data collection, analysis and interpretation, wrote the first draft of the manuscript, and contributed to subsequent revisions, in addition to having overall responsibility for the ROCKET study. PJW contributed to study design, data collection, statistical analysis and interpretation, and writing the manuscript. JEH contributed to study design, data analysis, interpretation and writing the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. DH and PW are both employed by Waikato District HealthBoard.

  • Competing interests The authors declare that there are no conflicts of interest.

  • Patient consent Not required.

  • Ethics approval The ROCKET study was approved by the Northern Y Regional Ethics Committee (reference 16/NTA/67).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement There are very few unpublished data related to this manuscript. Additional data may be available to researchers on application to the corresponding author.

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