Increasing numbers of infants are being born very preterm. These infants require intensive care and have a high risk of mortality and morbidity which has been associated with both hyperglycaemia and hypoglycaemia. In utero, glucose levels are normally maintained between 46 mmol/l, but infants born preterm are exposed to significant periods of both hyperglycaemia and hypoglycaemia. Early postnatal glucose control may be an important modifiable risk factor for clinical outcomes. However challenges remain in reducing hyperglycaemia without increasing hypoglycaemia. Many physiological parameters are monitored continuously to prevent wide fluctuations and the development of real time continuous glucose monitors provides the opportunity to monitor glucose levels in the same way. Managing glucose control in the preterm infant is also challenging due to the marked variability in insulin sensitivity between babies. The development of computer based algorithms, that can use the wealth of data obtained from the frequent glucose levels obtained by continuous glucose monitoring, could provide for individualized guidance on insulin treatment. We have used the combination of real time CGMs alongside a computer based algorithm to manage preterm infants: to reduce the prevalence of hyperglycaemia without increasing the risk of hypoglycaemia. This will help determine the impact of different strategies for nutritional management and glucose control, and what is optimal glucose control. It will be important to address the potential impact not just on short term outcomes but on longer term health.
10 - 12 Sep 2016
European Society for Paediatric Endocrinology