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Hauschild M, Monnard C, Eldridge AL, Antoniou MC, Bouthors T, Hansen E, Dwyer AA, Rytz A, Darimont C. Glucose variability in 6-12-month-old healthy infants. Front Nutr 2023; 10:1128389. [PMID: 37502727 PMCID: PMC10369064 DOI: 10.3389/fnut.2023.1128389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 06/15/2023] [Indexed: 07/29/2023] Open
Abstract
Background Metabolic programming of glucose homeostasis in the first 1,000 days of life may impact lifelong metabolic and cardiovascular health. Continuous glucose monitoring (CGM) devices may help measure the impact of dietary intake on glucose rhythms and metabolism in infants during the complementary feeding period. Objectives Demonstrate the feasibility of CGM to measure and quantify glucose variability in response to infant feeding and to evaluate associations between macronutrient meal composition and glucose variability. Methods The "FreeStyle Libre Pro®" device interstitial glucose meter was applied to the anterior thigh of 10 healthy 6-12-month-old infants. Parents recorded food intake, time of feeding, and used daily dairies to record sleep time and duration. Descriptive statistics were employed for food intake, sleep and key glycemic parameters over three full days. Mixed linear models were used to assess glycemic changes. Results Mid-day, afternoon, and evening feeds contained >30 g carbohydrate and induced higher 2-h iAUC (3.42, 3.41, and 3.50 mmol/L*h respectively) compared to early and mid-morning feedings with ≤25 g carbohydrates (iAUC 2.72 and 2.81 mmol/L*h, p < 0.05). Early morning and evening milk feedings contained approximately 9 g of fat and induced a longer time to reach maximal glucose value (Tmax; 75 and 68 min, respectively) compared to lower fat feedings (2.9-5.9 g; Tmax range: 34-60 min; p < 0.05). Incremental glucose value at time of food intake (C0) increased significantly from 0.24 ± 0.39 mM in early morning to 1.07 ± 0.57 mM in the evening (p < 0.05). Over the day, 70% of glucose values remained within the normal range (3.5-5.5 mmol/L), 10% were between 5.5-10 mmol/L, and 20% were < 3.5 mmol/L. Conclusion Our data support the feasibility of using CGM to measure glucose in 6-12-month-old infants. The observation of possible diurnal glucose variability and typical glucose values may have implications for future studies investigating metabolic adaptation to nutritional intake in early life.
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Affiliation(s)
- Michael Hauschild
- Pediatric Endocrinology, Diabetes and Obesity Unit, Department Woman-Mother-Child, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Cathriona Monnard
- Nestlé Institute of Health Sciences, Nestlé Research, Lausanne, Switzerland
| | - Alison L. Eldridge
- Nestlé Institute of Health Sciences, Nestlé Research, Lausanne, Switzerland
| | - Maria Christina Antoniou
- Pediatric Endocrinology, Diabetes and Obesity Unit, Department Woman-Mother-Child, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Thérèse Bouthors
- Pediatric Endocrinology, Diabetes and Obesity Unit, Department Woman-Mother-Child, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Erik Hansen
- Pediatric Endocrinology, Diabetes and Obesity Unit, Department Woman-Mother-Child, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Andrew A. Dwyer
- Boston College, William F. Connell School of Nursing, Chestnut Hill, MA, United States
| | - Andreas Rytz
- Clinical Research Unit, Nestlé Research, Lausanne, Switzerland
| | - Christian Darimont
- Nestlé Institute of Health Sciences, Nestlé Research, Lausanne, Switzerland
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Lu L, Xie C, Li X, Zhou Y, Yin Z, Wei P, Gao H, Wang J, Yong Y, Song J. Efficacy and safety of electrical acupoint stimulation for postoperative nausea and vomiting: A systematic review and meta-analysis. PLoS One 2023; 18:e0285943. [PMID: 37256901 PMCID: PMC10231798 DOI: 10.1371/journal.pone.0285943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/03/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Postoperative nausea and vomiting are typical postsurgical complications. Drug therapy is only partially effective. The goal of our meta-analysis is to systematically evaluate the efficacy and safety of electrical acupoint stimulation for postoperative nausea and vomiting and to score the quality of evidence supporting this concept. METHODS PubMed, Embase, Cochrane Library, Web of Science, and ClinicalTrials.gov were searched from inception to March 19, 2020. RESULTS Twenty-six studies (2064 patients) were included. Compared with control treatment, electrical acupoint stimulation reduced the incidence of postoperative nausea and vomiting (RR 0.49, 95% CI 0.41 to 0.57, P < 0.001), postoperative nausea (RR 0.55, 95% CI 0.47 to 0.64, P < 0.001) and postoperative vomiting (RR 0.56, 95% CI 0.45 to 0.70, P < 0.001). Electrical acupoint stimulation also reduced the number of patients requiring antiemetic rescue (RR 0.60, 95% CI 0.43 to 0.85, P = 0.004). No differences in adverse events were observed. Subgroup analysis showed that both electroacupuncture (RR 0.58, 95% CI 0.46 to 0.74, P < 0.001) and transcutaneous electrical acupoint stimulation (RR 0.44, 95% CI 0.34 to 0.58, P < 0.001) had significant effects. Electrical acupoint stimulation was effective whether administered preoperatively (RR 0.40, 95% CI 0.27 to 0.60, P < 0.001), postoperatively (RR 0.59, 95% CI 0.46 to 0.76, P < 0.001), or perioperatively (RR 0.50, 95% CI 0.37 to 0.67, P < 0.001). The quality of evidence was moderate to low. CONCLUSIONS Electrical acupoint stimulation probably reduce the incidence of postoperative nausea and vomiting, postoperative nausea, postoperative vomiting, and reduce the number of patients requiring antiemetic rescue, with few adverse events.
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Affiliation(s)
- Liyue Lu
- Department of Anesthesiology & Research Institute of Acupuncture Anesthesia, Shuguang Hospital Affiliated with Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Chenlong Xie
- Department of Anesthesiology & Research Institute of Acupuncture Anesthesia, Shuguang Hospital Affiliated with Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xing Li
- Department of Anesthesiology, Shuguang Hospital Affiliated with Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yalan Zhou
- Department of Anesthesiology, Shuguang Hospital Affiliated with Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zhiyu Yin
- Department of Anesthesiology, Shuguang Hospital Affiliated with Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Pan Wei
- Department of Anesthesiology, Shuguang Hospital Affiliated with Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hao Gao
- Department of Anesthesiology, Shuguang Hospital Affiliated with Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jian Wang
- Department of Anesthesiology, Shuguang Hospital Affiliated with Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yue Yong
- Department of Anesthesiology & Research Institute of Acupuncture Anesthesia, Shuguang Hospital Affiliated with Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Department of Anesthesiology, Shuguang Hospital Affiliated with Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jiangang Song
- Department of Anesthesiology & Research Institute of Acupuncture Anesthesia, Shuguang Hospital Affiliated with Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Department of Anesthesiology, Shuguang Hospital Affiliated with Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Wasiq MA, Behura SS, Sahoo S, Panda SK. Accuracy to detect neonatal hyperglycaemia using real-time continuous glucose monitoring during postoperative period. Eur J Pediatr 2023; 182:1083-1087. [PMID: 36574047 DOI: 10.1007/s00431-022-04777-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022]
Abstract
Identifying hyperglycaemia during postoperative period is essential for neonates. The objective of the study was to analyse the accuracy and reliability of continuous glucose monitoring (CGM) device for detecting hyperglycaemia during postoperative period in neonates. In this prospective study, hourly glucose recordings by CGM device and six hourly by glucometer glucose (GG-reference test for patient management) were collected in ten surgical neonates during first three postoperative days. Mean absolute relative difference (MARD) and proportion of CGM values within ± 15%/15 mg/dL, ± 20%/20 mg/dL, and ± 30%/30 mg/dL of GG, were analysed from matched pair CGM and GG recordings. The diagnostic performance of CGM for neonatal hyperglycaemia (> 150 mg/dL) was expressed as sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV); and the clinical reliability was assessed in Clarke Error Grid Analysis. A total of 720 CGM glucose readings, 120 matched -paired glucose readings by CGM --GG, and 37 episodes were hyperglycaemia by GG. The MARD was 10.76 %; the percentages of glucose readings within 15%/15 mg/dL, 20%/20 mg/dL, and 30%/30 mg/dL were 94.6%, 97.3% and 100% during the hyperglycaemia period. The sensitivity, specificity, PPV and NPV to detect hyperglycaaemia by CGM device were 100%, 93.9%, 88% and 100 % respectively. In Clarke Error Grid Analysis, 97.3 % points were in zone A and B during the hyperglycaemia period. CONCLUSION CGM device can be a clinically reliable tool for hyperglycaemia management during postoperative period in neonates. WHAT IS KNOWN • Neonates are vulnerable for hyperglycaemia during post-operative period and bed side glucometers are used for frequent glucose monitoring in them. • Continuous glucose monitor(CGM) devices are used for the glucose monitoring in adult and paediatric diabetes care. WHAT IS NEW • For the first time, this study analysed the accuracy and clinical reliability of FreeStyle Libre (CGM device) for identifying hyperglycaemia during post-operative period in neonates. • CGM device has very good accuracy for detecting hyperglycaemia in neonates, it may help the clinician for better glucose stability during post-operative period.
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Affiliation(s)
- Mohammed Abdul Wasiq
- Department of Pediatrics, Kalinga Institute of Medical Sciences, KIIT DU, Bhubaneswar, 751024, Odisha, India
| | - Sushree Smita Behura
- Department of Pediatrics, Kalinga Institute of Medical Sciences, KIIT DU, Bhubaneswar, 751024, Odisha, India
| | - Swaranjika Sahoo
- Department of Pediatrics, Kalinga Institute of Medical Sciences, KIIT DU, Bhubaneswar, 751024, Odisha, India
| | - Santosh Kumar Panda
- Department of Pediatrics, Kalinga Institute of Medical Sciences, KIIT DU, Bhubaneswar, 751024, Odisha, India.
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Kalogeropoulou MS, Iglesias-Platas I, Beardsall K. Should continuous glucose monitoring be used to manage neonates at risk of hypoglycaemia? Front Pediatr 2023; 11:1115228. [PMID: 37025284 PMCID: PMC10070986 DOI: 10.3389/fped.2023.1115228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 02/28/2023] [Indexed: 04/08/2023] Open
Abstract
The National Institute for Clinical Excellence (NICE) now recommends that continuous glucose monitoring (CGM) be offered to adults and children with diabetes who are at risk from hypoglycaemia. Hypoglycaemia is common in the neonatal period, and is a preventable cause of poor neurodevelopmental outcome, but is CGM helpful in the management of neonates at risk of hypoglycaemia? Neonatal studies have shown that CGM can detect clinically silent hypoglycaemia, which has been associated with reduced executive and visual function in early childhood. Intervention trials have further shown CGM can support the targeting of glucose levels in high-risk extremely preterm neonates. In spite of significant advances in technology, including smaller sensors, better accuracy and factory calibration, further progress and adoption into clinical practice has been limited as current devices are not designed nor have regulatory approval for the specific needs of the newborn. The use of CGM has the potential to support clinical management, and prevention of hypoglycaemia but must be set within its current limitations. The data CGM provides however also provides an important opportunity to improve our understanding of potential risks of hypoglycaemia and the impact of clinical interventions to prevent it.
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Affiliation(s)
| | - Isabel Iglesias-Platas
- Department of Paediatrics, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Kathryn Beardsall
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
- Department of Paediatrics, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
- Neonatal Intensive Care Unit, Rosie Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- Correspondence: Kathryn Beardsall
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Radhakrishnan S, Lakshmy S, Santhosh S, Kalarikkal N, Chakraborty B, Rout CS. Recent Developments and Future Perspective on Electrochemical Glucose Sensors Based on 2D Materials. BIOSENSORS 2022; 12:bios12070467. [PMID: 35884271 PMCID: PMC9313175 DOI: 10.3390/bios12070467] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/17/2022] [Accepted: 06/21/2022] [Indexed: 05/09/2023]
Abstract
Diabetes is a health disorder that necessitates constant blood glucose monitoring. The industry is always interested in creating novel glucose sensor devices because of the great demand for low-cost, quick, and precise means of monitoring blood glucose levels. Electrochemical glucose sensors, among others, have been developed and are now frequently used in clinical research. Nonetheless, despite the substantial obstacles, these electrochemical glucose sensors face numerous challenges. Because of their excellent stability, vast surface area, and low cost, various types of 2D materials have been employed to produce enzymatic and nonenzymatic glucose sensing applications. This review article looks at both enzymatic and nonenzymatic glucose sensors made from 2D materials. On the other hand, we concentrated on discussing the complexities of many significant papers addressing the construction of sensors and the usage of prepared sensors so that readers might grasp the concepts underlying such devices and related detection strategies. We also discuss several tuning approaches for improving electrochemical glucose sensor performance, as well as current breakthroughs and future plans in wearable and flexible electrochemical glucose sensors based on 2D materials as well as photoelectrochemical sensors.
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Affiliation(s)
- Sithara Radhakrishnan
- Centre for Nano and Material Science, Jain University, Jain Global Campus, Jakkasandra, Ramanagara, Bangalore 562 112, Karnataka, India;
| | - Seetha Lakshmy
- International and Inter University Centre for Nanoscience and Nanotechnology, Mahatma Gandhi University, Kottayam 686 560, Kerala, India; (S.L.); (S.S.); (N.K.)
| | - Shilpa Santhosh
- International and Inter University Centre for Nanoscience and Nanotechnology, Mahatma Gandhi University, Kottayam 686 560, Kerala, India; (S.L.); (S.S.); (N.K.)
| | - Nandakumar Kalarikkal
- International and Inter University Centre for Nanoscience and Nanotechnology, Mahatma Gandhi University, Kottayam 686 560, Kerala, India; (S.L.); (S.S.); (N.K.)
- School of Pure and Applied Physics, Mahatma Gandhi University, Kottayam 686 560, Kerala, India
- School of Nanoscience and Nanotechnology, Mahatma Gandhi University, Kottayam 686 560, Kerala, India
| | - Brahmananda Chakraborty
- High Pressure and Synchroton Radiation Physics Division, Bhabha Atomic Research Centre, Trombay, Mumbai 400 085, Maharashtra, India
- Homi Bhabha National Institute, Mumbai 400 094, Maharashtra, India
- Correspondence: (B.C.); or (C.S.R.)
| | - Chandra Sekhar Rout
- Centre for Nano and Material Science, Jain University, Jain Global Campus, Jakkasandra, Ramanagara, Bangalore 562 112, Karnataka, India;
- Correspondence: (B.C.); or (C.S.R.)
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Galderisi A, Trevisanuto D, Russo C, Hall R, Bruschettini M. Continuous glucose monitoring for the prevention of morbidity and mortality in preterm infants. Cochrane Database Syst Rev 2021; 12:CD013309. [PMID: 34931697 PMCID: PMC8690212 DOI: 10.1002/14651858.cd013309.pub3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Preterm infants are susceptible to hyperglycaemia and hypoglycaemia, which may lead to adverse neurodevelopment. The use of continuous glucose monitoring (CGM) devices might help in keeping glucose levels in the normal range, and reduce the need for blood sampling. However, the use of CGM might be associated with harms in the preterm infant. OBJECTIVES To assess the benefits and harms of CGM versus intermittent modalities to measure glycaemia in preterm infants 1. at risk of hypoglycaemia or hyperglycaemia; 2. with proven hypoglycaemia; or 3. with proven hyperglycaemia. SEARCH METHODS We searched CENTRAL (2021, Issue 4); PubMed; Embase; and CINAHL in April 2021. We also searched clinical trials databases, conference proceedings, and reference lists of retrieved articles for randomized controlled trials (RCTs) and quasi-RCTs. SELECTION CRITERIA We included RCTs and quasi-RCTs comparing the use of CGM versus intermittent modalities to measure glycaemia in preterm infants at risk of hypoglycaemia or hyperglycaemia; with proven hypoglycaemia; or with proven hyperglycaemia. DATA COLLECTION AND ANALYSIS We assessed the methodological quality of included trials using Cochrane Effective Practice and Organisation of Care Group (EPOC) criteria (assessing randomization, blinding, loss to follow-up, and handling of outcome data). We evaluated treatment effects using a fixed-effect model with risk ratio (RR) with 95% confidence intervals (CI) for categorical data and mean, standard deviation (SD), and mean difference (MD) for continuous data. We used the GRADE approach to assess the certainty of the evidence. MAIN RESULTS We included four trials enrolling 300 infants in our updated review. We included one new study and excluded another previously included study (because the inclusion criteria of the review have been narrowed). We compared the use of CGM to intermittent modalities in preterm infants at risk of hypoglycaemia or hyperglycaemia; however, one of these trials was analyzed separately because CGM was used as a standalone device, without being coupled to a control algorithm as in the other trials. We identified no studies in preterm infants with proven hypoglycaemia or hyperglycaemia. None of the four included trials reported the neurodevelopmental outcome (i.e. the primary outcome of this review), or seizures. The effect of the use of CGM on mortality during hospitalization is uncertain (RR 0.59, 95% CI 0.16 to 2.13; RD -0.02, 95% CI -0.07 to 0.03; 230 participants; 2 studies; very low-certainty evidence). The certainty of the evidence was very low for all outcomes because of limitations in study design, and imprecision of estimates. One study is ongoing (estimated sample size 60 infants) and planned to be completed in 2022. AUTHORS' CONCLUSIONS There is insufficient evidence to determine if CGM affects preterm infant mortality or morbidities. We are very uncertain of the safety of CGM and the available management algorithms, and many morbidities remain unreported. Preterm infants at risk of hypoglycaemia or hyperglycaemia were enrolled in all four included studies. No studies have been conducted in preterm infants with proven hypoglycaemia or hyperglycaemia. Long-term outcomes were not reported. Events of necrotizing enterocolitis, reported in the study published in 2021, were lower in the CGM group. However, the effect of CGM on this outcome remains very uncertain. Clinical trials are required to determine the most effective CGM and glycaemic management regimens in preterm infants before larger studies can be performed to assess the efficacy of CGM for reducing mortality, morbidity, and long-term neurodevelopmental impairments.
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Affiliation(s)
- Alfonso Galderisi
- Pediatrics Endocrinology, Yale University, New Haven, Connecticut, USA
| | - Daniele Trevisanuto
- Department of Woman's and Child's Health, University of Padova, Padova, Italy
| | | | - Rebecka Hall
- Informatics & Technology (IT) Services, Cochrane, Copenhagen, Denmark
| | - Matteo Bruschettini
- Department of Clinical Sciences Lund, Paediatrics, Lund University, Skåne University Hospital, Lund, Sweden
- Cochrane Sweden, Lund University, Skåne University Hospital, Lund, Sweden
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Continuous glucose monitoring in the neonatal intensive care unit: need for practical guidelines. THE LANCET CHILD & ADOLESCENT HEALTH 2021; 5:e15. [PMID: 33864743 DOI: 10.1016/s2352-4642(21)00096-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 03/22/2021] [Indexed: 12/15/2022]
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Galderisi A, Bruschettini M, Russo C, Hall R, Trevisanuto D. Continuous glucose monitoring for the prevention of morbidity and mortality in preterm infants. Cochrane Database Syst Rev 2020; 12:CD013309. [PMID: 33348448 PMCID: PMC8092644 DOI: 10.1002/14651858.cd013309.pub2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Preterm infants are susceptible to hyperglycemia and hypoglycemia, conditions which may lead to adverse neurodevelopment. The use of continuous glucose monitoring devices (CGM) might help keeping glucose levels in the normal range, and reduce the need for blood sampling. However, the use of CGM might be associated with harms in the preterm infant. OBJECTIVES Objective one: to assess the benefits and harms of CGM alone versus standard method of glycemic measure in preterm infants. Objective two: to assess the benefits and harms of CGM with automated algorithm versus standard method of glycemic measure in preterm infants. Objective three: to assess the benefits and harms of CGM with automated algorithm versus CGM without automated algorithm in preterm infants. SEARCH METHODS We adopted the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2020, Issue 9), in the Cochrane Library; MEDLINE via PubMed (1966 to 25 September 2020); Embase (1980 to 25 September 2020); and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (1982 to 25 September 2020). We also searched clinical trials databases, conference proceedings, and reference lists of retrieved articles for randomized controlled trials and quasi-randomized trials. SELECTION CRITERIA Randomized controlled trials (RCTs) and quasi-RCTs in preterm infants comparing: 1) the use of CGM versus intermittent modalities to measure glycemia (comparison 1); or CGM associated with prespecified interventions to correct hypoglycemia or hyperglycemia versus CGM without such prespecified interventions (comparison 2). DATA COLLECTION AND ANALYSIS We assessed the methodological quality of included trials using Cochrane Effective Practice and Organisation of Care Group (EPOC) criteria (assessing randomization, blinding, loss to follow-up, and handling of outcome data). We evaluated treatment effects using a fixed-effect model with risk ratio (RR) for categorical data and mean, standard deviation (SD), and mean difference (MD) for continuous data. We used the GRADE approach to assess the certainty of the evidence. MAIN RESULTS Four trials enrolling 138 infants met our inclusion criteria. Investigators in three trials (118 infants) compared the use of CGM to intermittent modalities (comparison one); however one of these trials was analyzed separately because CGM was used as a standalone device, without being coupled to a control algorithm like in the other trials. A fourth trial (20 infants) assessed CGM with an automated algorithm versus CGM with a manual algorithm. None of the four included trials reported the neurodevelopmental outcome, i.e. the primary outcome of this review. Within comparison one, the certainty of the evidence on the use of CGM on mortality during hospitalization is very uncertain (typical RR 3.00, 95% CI 0.13 to 70.30; typical RD 0.04, 95% CI -0.06 to 0.14; 50 participants; 1 study; very low certainty). The number of hypoglycemic episodes was reported in two studies with conflicting data. The number of hyperglycemic episodes was reported in one study (typical MD -1.40, 95% CI -2.84 to 0.04; 50 participants; 1 study). The certainty of the evidence was very low for all outcomes because of limitations in study design, and imprecision of estimates. Three studies are ongoing. AUTHORS' CONCLUSIONS There is insufficient evidence to determine if CGM improves preterm infant mortality or morbidities. Long-term outcomes were not reported. Clinical trials are required to determine the most effective CGM and glycemic management regimens in preterm infants before larger studies can be performed to assess the efficacy of CGM for reducing mortality, morbidity and long-term neurodevelopmental impairments. The absence of CGM labelled for neonatal use is still a major limit in its use as well as the absence of dedicated neonatal devices.
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Affiliation(s)
| | - Matteo Bruschettini
- Department of Clinical Sciences Lund, Paediatrics, Lund University, Skåne University Hospital, Lund, Sweden
- Cochrane Sweden, Lund University, Skåne University Hospital, Lund, Sweden
| | | | - Rebecka Hall
- Informatics and Technology (IT) Services Department, Cochrane Central Executive, Copenhagen, Denmark
| | - Daniele Trevisanuto
- Department of Woman's and Child's Health, University of Padova, Padova, Italy
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