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Abstract
Objective The Glucose in Well Babies (GLOW) Study showed that there are two phases of low glucose concentrations in healthy newborn infants: an initial phase in which plasma concentrations of ketones are low; and a second phase in which low glucose concentrations are accompanied by elevated concentrations of ketones. The implications of these two phases for the brain differ depending on whether ketones are available as alternative substrate for brain metabolism. The purpose of this study was to estimate the duration of these two phases of neonatal low glucose concentrations in 66 healthy breastfed newborns from the GLOW Study during the first 5 days of life.
Methods The sum of glucose and beta-hydroxybutyrate (BOHB) was used as a proxy for the total concentrations of insulin-dependent fuels for the brain; a threshold value below 4 mmol/L was taken to indicate the presence of relative hyperinsulinism and a BOHB concentration above 0.5 mmol/L to indicate ketonaemia.
Results The first phase of low glucose concentrations lasted a median of 40 hours and in 15% of infants, this persisted beyond 60 hours. Fifty (76%) of the 66 infants subsequently had ketonaemia, which resolved at a median age of 76 hours (range 41–>120 hours).
Conclusions These data suggest that monitoring BOHB concentrations may be useful for interpreting glucose concentrations in newborns and screening for persistent hyperinsulinism.
- Endocrinology
- Neonatology
Data availability statement
Data are available upon reasonable request.
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Data availability statement
Data are available upon reasonable request.
Footnotes
Twitter @DeborahHarrisNP
Contributors Concept and design—CAS, PJW, DLH, DDDL and JEH. Data collection—PJW, DLH and JEH. Data analysis—PJW. Writing (original draft)—CAS. Writing (review and editing)—PJW, DLH, DDDL and JEH. DDDL is the guarantor of this work and takes full responsibility for the work and conduct of the study, had access to the data, and controlled the decision to publish.
Funding The GLOW Study was supported by the Waikato Sick Babies Trust and by the Health Research Council of New Zealand (award 19/690) and the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health (R01HD091075).
Disclaimer The content is solely the responsibility of the authors and does not necessarily represent the official views of the Eunice Kennedy Shriver National Institute of Child Health & Human Development or the National Institutes of Health.
Competing interests DDDL has received consulting fees from Zealand Pharma, Crinetics Pharmaceuticals, Hanmi Pharmaceuticals, Eiger Pharma, Twist Biosciences and Rhythm Pharmaceuticals; has received research funding from Zealand Pharma, Rezolute, Crinetics Pharmaceuticals, Hanmi Pharmaceuticals, Twist Biosciences, Eiger Pharma and Ultragenyx for studies not discussed in this manuscript. CAS serves on the Data and Safety Monitoring Board for Zealand Pharma clinical trials in hyperinsulinism. DDDL and CAS serve on the Scientific Advisory Board for Congenital Hyperinsulinism International.
Provenance and peer review Not commissioned; externally peer reviewed.
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