Children, and many adults, flinch at the very idea of having blood drawn for routine lab tests.
Yet many newborns, at-risk for low blood sugar levels, can have their heels pricked with needles several times a day while they are in the hospital.
Low blood sugar, called hypoglycemia, is the most common metabolic disturbance in newborns, and the culprit behind a number of childhood difficulties. It affects approximately 15% of all newborns in the U.S. annually.
Infants born to mothers with diabetes, infants both large and small for their gestational age, and late preterm infants are at greatest risk for neonatal hypoglycemia, said Dr. Neha Patel of the Pennsylvania State University at Hershey.
Her Gerber Foundation-funded study is helping Dr. Patel explore a way to adequately monitor these infants’ blood sugar levels without the need for so many painful heel pricks.
“Newborns who have multiple needle sticks have a harder time tolerating routine childhood immunizations and blood draws,’ Dr. Patel said. In animals, multiple heel sticks have been shown to change brain development, she added.
She believes it is essential to discover and use new technologies for hypoglycemic and sick newborns that reduce painful stimuli. In her experience, some hypoglycemic infants may have as many as 50 painful needle sticks during their hospitalizations.
Rather than the intermittent process used today, in which blood is drawn for screening every few hours using point-of-care glucometers, Dr. Patel is testing a method called continuous glucose monitoring.
Although approved by the Food and Drug Administration for children older than age 2, and tested with extremely premature infants, continuous glucose monitoring has not been analyzed for the at-risk newborns targeted by the American Academy of Pediatrics for routine glucose screening.
With a goal of enrolling 100 newborns, Dr. Patel says her study will provide data for larger trials to evaluate the effectiveness of continuous glucose monitoring.
“You can imagine that parents can become quite distraught when they see their baby being poked so often to get blood samples,” Dr. Patel said. “We use continuous glucose monitors with older children, and wouldn’t it be wonderful if these monitors could work with newborns, too?”
The continuous glucose monitoring system that Dr. Patel is evaluating tracks glucose levels throughout the day and night, providing alerts if sugar levels go too high or low.
There is only one needle stick, when the sensor is placed just beneath the baby’s skin. A transmitter attached to the sensor continuously sends the glucose concentrations to a receiver electronically via Bluetooth technology.
“Our aim is to determine whether the baby can tolerate this sensor, and whether the sensor is accurate for making clinical decisions with no increased risk to babies, such as infection,” she said.
One advantage of the continuous monitor is knowing what happens to glucose concentrations between samples. “We do not know how quickly concentrations change with or without treatment, the duration of hypoglycemia, and the lowest concentrations,” Dr. Patel said.
With neonatal hypoglycemia affecting some 500,000 newborns in the U.S. every year, “we anticipate our data, and the future prospective trials we conduct, will provide clarity for clinical monitoring and treatment and improve long-term neurodevelopment in this large population,” Dr. Patel added.
“I want to thank The Gerber Foundation for helping us pursue this project,” she said.
“I very much appreciate the foundation’s confidence and their willingness to work with us. I truly believe this work will prove to be a springboard for research on a larger scale.”
