Cot-side electroencephalography monitoring is not clinically useful in the detection of mild neonatal hypoglycemia
Abstract
Objectives To determine whether there is a relationship between electroencephalography patterns and hypoglycemia, by using simultaneous cot-side amplitude integrated electroencephalography (aEEG) and continuous interstitial glucose monitoring, and whether non-glucose cerebral fuels modified these patterns.Study design Eligible babies were ≥ 32 weeks gestation, at risk for hypoglycemia, and admitted to the neonatal intensive care unit. Electrodes were placed in C3-P3, C4-P4 O1-O2 montages. A continuous interstitial glucose sensor was placed subcutaneously, and blood glucose was measured by using the glucose oxidase method. Non-glucose cerebral fuels were measured at study entry, exit, and during recognized hypoglycemia.Results A total of 101 babies were enrolled, with a median weight of 2179 g and gestation of 35 weeks. Twenty-four of the babies had aEEG recordings, and glucose concentrations were low (< 2.6 mM). There were 103 episodes of low glucose concentrations lasting 5 to 475 minutes, but no observable changes in aEEG variables. Plasma concentrations of lactate, beta-hydroxybutyrate, and glycerol were low and did not alter during hypoglycemia.Conclusions Cot-side aEEG was not useful for the detection of neurological changes during mild hypoglycemia. Plasma concentrations of non-glucose cerebral fuels were low and unlikely to provide substantial neuroprotection.
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There is no assurance that the plasma lactate level will be sufficiently elevated to compensate for low glucose in high-risk neonates.
“Of concern, as noted previously,3 plasma ketone levels are suppressed during hypoglycemia in high-risk neonates, making them particularly vulnerable to hypoglycemia-induced brain damage, and there is no assurance the plasma lactate level will be sufficiently elevated to compensate for low glucose.27,28,30,39”
From Recommendations from the Pediatric Endocrine Society for evaluation and management of persistent hypoglycemia in neonates, infants, and children (2015) · cites this paper as [39]
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- Authors
- Harris, D. L., Weston, P. J., Williams, C. E., Pleasants, A. B., Battin, M. R., Spooner, C. G., & Harding, J. E.
- Affiliations
- University of Auckland (NZ)
- Waikato District Health Board (NZ)
- Starship Children's Health (NZ)
- Corresponding author
- Harding, Jane E.
- Venue
- The Journal of Pediatrics
- Publisher
- Elsevier BV
- Published
- 2011-11
- Volume
- 159
- Issue
- 5
- Pages
- 755-760.e1
- ISSN
- 0022-3476 (ISSN-L)
- OpenAlex
- W2044695892
- Cited by
- 23
- References
- 39
- Citations by year
- 2024: 1 · 2022: 3 · 2021: 3 · 2020: 2 · 2019: 2 · 2017: 3 · 2016: 1 · 2015: 2 · 2014: 4 · 2013: 1
- FWCI
- 1.47
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Pediatrics (publishedVersion)
- PubMed (publishedVersion)
- ResearchSpace (University of Auckland) (submittedVersion)
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Neonatal and fetal brain pathology
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Neonatal Health and Biochemistry
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Infant Development and Preterm Care
- Keywords
- neonatal hypoglycemia, amplitude-integrated electroencephalography, lactate, beta-hydroxybutyrate, glycerol, neuroprotection, hypoglycemia detection
- MeSH terms
- Blood Glucose, Electroencephalography, Glucose Oxidase, Glycerol, Humans, Hypoglycemia, Infant, Newborn, Intensive Care Units, Neonatal, Male, Monitoring, Physiologic, Point-of-Care Systems, Lactic Acid, 3-Hydroxybutyric Acid
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