Glucose disturbances in very low birth weight infants nearing term age—results from the prospective LIGHT-study using continuous glucose monitoring

TL;DR

This study finds that many very low birth weight infants have glucose issues near term age, and continuous glucose monitoring can help detect these issues.

Contribution

The study confirms subclinical glucose disturbances in preterm infants nearing term age and identifies male sex and insulin treatment as risk factors.

Findings

68.6% of very low birth weight infants had protracted dysglycemia at 36 weeks postmenstrual age.

Male sex was linked to longer hyperglycemia, and insulin treatment was linked to longer hypoglycemia.

Continuous glucose monitoring showed strong correlation with capillary glucose measurements.

Abstract

The purpose of the study is to assess the prevalence of glucose disturbances (dysglycemia) in very low birth weight (VLBW) infants at 36 weeks postmenstrual age (PMA) using a continuous glucose monitoring (CGM) system and to identify possible risk factors for these disturbances. A prospective observational cohort study (VLBW Infants—Glucose and Hormonal Profiles over Time; LIGHT) included 35 VLBW infants admitted to a single tertiary neonatal intensive care unit during 2016–2019. Perinatal data were registered prospectively. CGM registration was performed at 36 weeks PMA for a period of 48 h. Protracted hyperglycemia and hypoglycemia were defined as > 30 min with glucose concentrations > 8 mmol/L or < 2.6 mmol/L, respectively. A total of 19,907 measurements were retrieved and analyzed. Protracted dysglycemia was found in 68.6% of infants, with 51% of infants experiencing hyperglycemia (4.5% of registration time) and 40% experiencing hypoglycemia (1.2% of registration time). Male sex was associated with longer time spent in hyperglycemia. Insulin treatment prior to 36 weeks PMA was associated with longer time spent in hypoglycemia. CGM values correlated strongly with capillary glucose measurements, and no values fell within clinically dangerous ranges.

Conclusion: Protracted dysglycemia is common in VLBW infants even at 36 weeks PMA. Identification of risk factors for dysglycemia might help delineate certain patients in need of careful monitoring of glucose concentrations even when nearing term age. CGM is a promising tool for glucose monitoring in the neonatal intensive care unit.

What is Known?• Preterm infants are prone to glucose disturbances in the first weeks of life.• There is some evidence suggesting glucose disturbances are common in preterm infants nearing term age.• Glucose disturbances are associated with morbidity and mortality.What is New?• Continuous glucose registration data confirms subclinical glucose disturbances are common in preterm infants nearing term age.• Male sex and insulin treatment prior to 36 weeks postmenstrual age seem to be associated with glucose disturbances at 36 weeks postmenstrual age.

The online version contains supplementary material available at 10.1007/s00431-025-06284-5.

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