Background: preterm infants are particularly vulnerable to glycaemic instability, a condition associated with increased neonatal morbidity and adverse neurodevelopmental outcomes. Continuous glucose monitoring (CGM) has emerged as a promising tool for improving metabolic management by enabling continuous assessment of glucose fluctuations. This study aimed to evaluate whether real-time CGM improves glycaemic control and influences brain development and neurodevelopmental outcomes compared with standard intermittent glucose monitoring in very preterm infants. Methods: a single-centre prospective randomized controlled trial was conducted in a tertiary Neonatal Intensive Care Unit between January 2022 and August 2023. Preterm infants were randomized within six hours of birth to either real-time CGM-guided management or standard care with blinded CGM. Glycaemic management in the intervention group was adjusted according to continuous real-time glucose trends, whereas treatment decisions in the control group relied on intermittent blood glucose measurements. Primary outcomes included frequency and duration of hypoglycaemic (<47 mg/dL) and hyperglycaemic (>180 mg/dL) episodes. Secondary outcomes comprised assessment of glycaemic variability using the Mean Amplitude of Glycaemic Excursions (MAGE), evaluation of white matter microstructural maturation through tract-based spatial statistics (TBSS) at 33 weeks postmenstrual age and at term-equivalent age, and neurodevelopmental assessment at two years corrected age using the Griffiths Scales of Child Development. Results: fifty-three infants were enrolled (real-time CGM: n=26; control: n=27). Infants monitored with real-time CGM showed a significant reduction in both hypoglycaemic and hyperglycaemic episodes during the first week of life and at 32 weeks postmenstrual age. Despite improved metabolic stability, no significant differences were observed in white matter microstructure or neurodevelopmental outcomes at two years corrected age. Conclusions: real-time CGM significantly improves metabolic stability in very preterm infants by reducing dysglycaemic episodes and glycaemic variability, factors potentially relevant for neuroprotection. The absence of detectable neurodevelopmental differences may reflect limited statistical power or the multifactorial nature of preterm brain injury. Larger multicentre studies are warranted to clarify the long-term neurological impact of CGM-guided metabolic management and to support the development of evidence-based neonatal glucose control strategies.
Improving Metabolic Stability in Preterm Infants Using Continuous Glucose Monitoring: A Randomized Study
BATTAGLINI, MARCELLA
2026-05-27
Abstract
Background: preterm infants are particularly vulnerable to glycaemic instability, a condition associated with increased neonatal morbidity and adverse neurodevelopmental outcomes. Continuous glucose monitoring (CGM) has emerged as a promising tool for improving metabolic management by enabling continuous assessment of glucose fluctuations. This study aimed to evaluate whether real-time CGM improves glycaemic control and influences brain development and neurodevelopmental outcomes compared with standard intermittent glucose monitoring in very preterm infants. Methods: a single-centre prospective randomized controlled trial was conducted in a tertiary Neonatal Intensive Care Unit between January 2022 and August 2023. Preterm infants were randomized within six hours of birth to either real-time CGM-guided management or standard care with blinded CGM. Glycaemic management in the intervention group was adjusted according to continuous real-time glucose trends, whereas treatment decisions in the control group relied on intermittent blood glucose measurements. Primary outcomes included frequency and duration of hypoglycaemic (<47 mg/dL) and hyperglycaemic (>180 mg/dL) episodes. Secondary outcomes comprised assessment of glycaemic variability using the Mean Amplitude of Glycaemic Excursions (MAGE), evaluation of white matter microstructural maturation through tract-based spatial statistics (TBSS) at 33 weeks postmenstrual age and at term-equivalent age, and neurodevelopmental assessment at two years corrected age using the Griffiths Scales of Child Development. Results: fifty-three infants were enrolled (real-time CGM: n=26; control: n=27). Infants monitored with real-time CGM showed a significant reduction in both hypoglycaemic and hyperglycaemic episodes during the first week of life and at 32 weeks postmenstrual age. Despite improved metabolic stability, no significant differences were observed in white matter microstructure or neurodevelopmental outcomes at two years corrected age. Conclusions: real-time CGM significantly improves metabolic stability in very preterm infants by reducing dysglycaemic episodes and glycaemic variability, factors potentially relevant for neuroprotection. The absence of detectable neurodevelopmental differences may reflect limited statistical power or the multifactorial nature of preterm brain injury. Larger multicentre studies are warranted to clarify the long-term neurological impact of CGM-guided metabolic management and to support the development of evidence-based neonatal glucose control strategies.
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