Continuous glucose monitoring in very preterm infants shows low ketones and higher lactate in first week
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Key Takeaway
Consider that very preterm infants show low ketones and higher lactate in the first week, but findings are observational and not causal.
This prespecified substudy of an RCT analyzed 168 very low birth weight infants (85 females) in an international multicentre setting. The intervention was continuous glucose monitoring in glycaemic care from the REACT trial; the comparator for this substudy was not reported in the abstract. The primary outcome was ketone and lactate concentrations in the first week of life.
Lactate concentrations were higher initially and lowered over time, with a mean (SD) of 1.72 (1.26) mmol/L on day 2 and 1.19 (1.1) mmol/L on day 7. Ketone concentrations were consistently low at 0.1 mmol/L. Relationships with blood glucose, macronutrient intake, and insulin treatment were not consistently related to ketone or lactate concentrations.
Safety and tolerability were not reported; no adverse events, serious adverse events, or discontinuations were described. Key limitations include that the abstract does not report comparator details for the substudy, no p-values or confidence intervals are provided, and findings are limited to the first week of life.
Practice relevance highlights persistently low ketones and relatively higher lactate in very preterm infants, suggesting a need for future research on metabolites during hypoglycaemia or hyperglycaemia. Causality cannot be inferred from this observational substudy of an RCT.
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View Original Abstract ↓
BACKGROUND: Ketones and lactate may contribute towards overall cerebral fuel availability in term infants, yet the availability of such cerebral fuels in very preterm infants is unclear. We undertook a prespecified substudy to explore ketone and lactate concentrations in the first week of life in infants recruited to the REACT trial (real-time continuous glucose monitoring in the newborn): an international multicentre randomised controlled trial of 182 very low birth weight infants investigating the use of continuous glucose monitoring in glycaemic care.
METHODS: Ketone and lactate measurements were prospectively collected over the first week of life using the Nova Biomedical point-of-care meter. A longitudinal analysis was undertaken to explore lactate and ketone concentration trends across time and their relationships with blood glucose, baseline demographics, nutritional support and insulin treatment.
RESULTS: Data were available for 168 infants (85 females) including 2902 blood glucose, 2084 ketone and 2017 lactate samples. The mean (SD) gestational age was 27.4 (2.0) weeks. Lactate concentrations were higher initially, with mean (SD) 1.72 (1.26) mmol/L on day 2 and lowered to 1.19 (1.1) mmol/L on day 7. Ketone concentrations remained consistently low at 0.1 mmol/L. Neither simultaneous blood glucose concentrations, macronutrient intake nor receipt of insulin was consistently related to ketone or lactate concentrations.
CONCLUSION: In this cohort of very preterm infants, there were persistently low concentrations of ketones and relatively higher concentrations of lactate throughout the first week of life. Future research should evaluate changes in these metabolites during episodes of acute hypoglycaemia or hyperglycaemia over more prolonged periods of neonatal intensive care.
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