Feasibility and Safety of Continuous Glucose Monitoring in Infants at Risk of Hypoglycemia in a Rooming-in Setting.

Background:Screening of neonatal hypoglycemia uses currently intermittent blood sampling. Continuous glucose monitoring (CGM) allows for tighter glucose control and better comfort for newborns and parents. CGM has previously been used in intensive care setting or blinded to clinicians. Our pilot study uses CGM in real time in rooming-in setting. Methods: CGM was attached within first two hours of life. Low glucose readings were verified to prevent overtreatment. Pairs of sensor readings and corresponding blood glucose measurements were assessed retrospectively. Neurodevelopmental evaluation was performed at 24 months. Results: 44 infants were enrolled. Three had verified hypoglycemia found due to CGM. No patient was below 2 standard deviations in any components of Bayley scales. Median scores were: Cognitive 100, language 86, motor 94. Conclusion: Use of CGM in a rooming-in environment is safe from clinical and neurodevelopmental point of view. Randomized trials are needed to evaluate superiority in longer term outcomes.

Continuous glucose monitoring as a screening tool for neonatal hypoglycemia in infants of diabetic mothers.

Objective: To assess the plausibility of using the continuous glucose monitoring as a sole source of data for the screening of the neonatal hypoglycemia.Study design: Infants of mothers with diabetes were screened for neonatal hypoglycemia (less than 2.5 mmol/l after 4 h of life). Initial measurement was performed using point of care analyzer. We applied continuous glucose monitoring system subsequently. Infants were monitored up to 5 days or until discharge.Results: Out of 32 infants 11 had postnatal hypoglycemia resolved within 12 h of life. Two infants had hypoglycemia found due to continuous glucose monitoring after 24 h of life when sufficient feeding was established and they did not show any signs of hypoglycemia. We did not have any false negative measurements. No infant showed clinical signs of neonatal hypoglycemia.Conclusions: Continuous glucose monitoring is plausible and safe to use for screening of neonatal hypoglycemia. It operates well within the range that is accepted as safe for neurodevelopment. In addition, it can be used after first day of life where regular screening ends. Limitation of this method is possible alarm negligence of caregivers.

Conducting labor in women with previous caesarean section in a low gestational week. A prospective case-controlled study.

AIMS: To assess whether vaginal labor after a previous caesarean section in a low gestational week performed by means of a high placed U-section technique could be recommended by obstetricians as a sufficiently safe method of choice for pregnant women. METHODS: Of 309 pregnant women with a history of a high placed U-section, 166 (53.7%) met the criteria for the subsequent vaginal delivery and agreed with it. In 78%, vaginal labor started spontaneously and in 22% it was induced due to postterm pregnancy or preterm rupture of membranes. RESULTS: Vaginal labor was successful in 72.3% of women. Deliveries after spontaneous onset of uterine contractions (80%) were considerably more successful. In the group of women with induced labor, the success rate was below 50%. Uterine rupture was not encountered in the study group. CONCLUSIONS: Vaginal labor after a previous high placed U-section is a sufficiently safe method of choice for selected groups of pregnant women, but it has to be mentioned that selecting criteria can only minimize and not entirely exclude the risk of uterine rupture.

Guidelines for the Management of Extremely Premature Deliveries: A Systematic Review.

BACKGROUND AND OBJECTIVES: Available data on survival rates and outcomes of extremely low gestational age (GA) infants (22-25 weeks' gestation) display wide variation by country. Whether similar variation is found in statements by national professional bodies is unknown. The objectives were to perform a systematic review of management from scientific and professional organizations for delivery room care of extremely low GA infants. METHODS: We searched Embase, PubMed, and Google Scholar for management guidelines on perinatal care. Countries were included if rated by the United Nations Development Programme's Human Development Index as "very highly developed." The primary outcome was rating of recommendations from "comfort care" to "active care." Secondary outcomes were specifying country-specific survival and considering potential for 3 biases: limitations of GA assessment; bias from different definitions of stillbirths and live births; and bias from the use of different denominators to calculate survival. RESULTS: Of 47 highly developed countries, 34 guidelines from 23 countries and 4 international groups were identified. Of these, 3 did not state management recommendations. Of the remaining 31 guidelines, 21 (68%) supported comfort care at 22 weeks' gestation, and 20 (65%) supported active care at 25 weeks' gestation. Between 23 and 24 weeks' gestation, much greater variation was seen. Seventeen guidelines cited national survival rates. Few guidelines discussed potential biases: limitations in GA (n = 17); definition bias (n = 3); and denominator bias (n = 7). CONCLUSIONS: Although there is a wide variation in recommendations (especially between 23 and 24 weeks' GA), there is general agreement for comfort care at 22 weeks' GA and active care at 25 weeks' GA.

Maternal BMI and HDL as predictors of pregnancy outcome in women with type 1 diabetes.

OBJECTIVE: Diabetes in pregnancy is associated with increased risks of maternal as well as foetal complications. METHODS: Retrospective data on 96 women and their 96 newborns were anonymously statistically analysed to assess pregnancies of type 1 diabetes (T1D) women managed in our hospital in past nine years. The outcomes of the neonates were divided into three categories according to the clinical status, presence of congenital abnormalities and infant's treatment. RESULTS: We found out that the outcome of newborn infants associated with maternal HbA1c before gestation as well as during the whole course of pregnancy (p < 0.02 for all). Surprisingly, neonatal outcome was strongly associated with the maternal BMI (p < 0.05). In our model, a lowering of BMI by one grade led to an 18% increase in the chance that the newborn will have no health problems. We did not observe an important worsening of chronic diabetic complications in mothers; however, regarding maternal clinical status, we found that preeclampsia occurrence was strongly and independently connected to HDL level (p < 0.01). CONCLUSION: Our data demonstrate that lower pregestational BMI could substantially improve T1D mothers' pregnancy outcome. Lower HDL levels in T1D mothers during pregnancy correlate with higher risk of preeclampsia development.

Experience with real time continuous glucose monitoring in stabilising fluctuating glycaemia during intensive care of the preterm infant of a diabetic mother.

OBJECTIVE: The newborns of diabetic mothers suffer from perinatal complications more frequently than the newborns of healthy women. METHODS: We used for 7 days a real time continuous glucose monitoring system (RT-CGMS) to monitor glucose homeostasis and manage glucose administration in a premature newborn of a diabetic mother. RESULTS: The boy was born at 35 + 5 gestational weeks with typical signs of diabetic fetopathy. RT-CGMS revealed 2 late hypoglycaemia episodes on the 2nd and 4th days. The sensor readings correlated well with glycaemia measured in the laboratory (r = 0.908, p = 0.005). To support conclusions of this case report, we attached the data of five other preterm newborns of diabetic mothers who were later successfully treated according to the RT-CGMS data as well. CONCLUSIONS: This approach allows timely response to glycaemia instability and is applicable even in preterm infants.