Clinical Aspects of Neonatal Hypoglycemia: A Mini Review.
Clinical Aspects of Neonatal Hypoglycemia: A Mini Review.
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DOI：
10.3389/fped.2020.562251
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发表时间：
2020
影响因子：
2.6
通讯作者：
Harding JE
中科院分区：
文献类型：
--
作者：
Edwards T;Harding JE
简介：新生儿低血糖是常见的，是脑损伤的一个可预防的原因。治疗的目的是预防或减少脑损伤。本文旨在总结新生儿一过性低血糖症的最新进展和临床思考。结果：低血糖风险最高的婴儿群体得到了很好的界定。然而，低血糖筛查的最佳频率和持续时间，以及治疗预防脑损伤的阈值仍然不确定。在研究环境中连续间质血糖监测提供了关于血糖控制的有用信息，包括低血糖的持续时间、频率和严重程度。然而，目前尚不清楚持续监测是否与临床受益或损害相关。口服葡萄糖凝胶越来越多地被推荐作为新生儿低血糖的一线治疗。有证据表明，即使是短暂的和临床上未检测到的新生儿低血糖发作也与不良后遗症有关，这表明也应考虑预防。轻度短暂性低血糖与学龄前儿童的神经发育障碍无关，但与儿童后期的视觉运动和执行功能低下、神经发育障碍以及识字和数学成绩差相关。结论：我们目前的新生儿低血糖管理缺乏可靠的证据基础。需要随机试验来评估不同预防和治疗策略的效果，但需要有足够的把握度来评估至少到学龄的结果。
Introduction: Neonatal hypoglycemia is common and a preventable cause of brain damage. The goal of management is to prevent or minimize brain injury. The purpose of this mini review is to summarize recent advances and current thinking around clinical aspects of transient neonatal hypoglycemia. Results: The groups of babies at highest risk of hypoglycemia are well defined. However, the optimal frequency and duration of screening for hypoglycemia, as well as the threshold at which treatment would prevent brain injury, remains uncertain. Continuous interstitial glucose monitoring in a research setting provides useful information about glycemic control, including the duration, frequency, and severity of hypoglycemia. However, it remains unknown whether continuous monitoring is associated with clinical benefits or harms. Oral dextrose gel is increasingly being recommended as a first-line treatment for neonatal hypoglycemia. There is some evidence that even transient and clinically undetected episodes of neonatal hypoglycemia are associated with adverse sequelae, suggesting that prophylaxis should also be considered. Mild transient hypoglycemia is not associated with neurodevelopmental impairment at preschool ages, but is associated with low visual motor and executive function, and with neurodevelopmental impairment and poor literacy and mathematics achievement in later childhood. Conclusion: Our current management of neonatal hypoglycemia lacks a reliable evidence base. Randomized trials are required to assess the effects of different prophylactic and treatment strategies, but need to be adequately powered to assess outcomes at least to school age.
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