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Continuous intersticial glycose level in normal newborns

Grant number: 14/02039-4
Support type:Regular Research Grants
Duration: November 01, 2014 - October 31, 2017
Field of knowledge:Health Sciences - Medicine - Maternal and Child Health
Principal Investigator:Raphael Del Roio Liberatore Junior
Grantee:Raphael Del Roio Liberatore Junior
Home Institution: Faculdade de Medicina de Ribeirão Preto (FMRP). Universidade de São Paulo (USP). Ribeirão Preto , SP, Brazil

Abstract

At birth the supply of glucose is suddenly interrupted the that is essential for activation of energy metabolism. There is a series of metabolic and hormonal changes during labor until the ligation of the umbilical cord which makes it possible to keep the blood glucose homeostasis. With the progression of labor, the fetal simpatoadrenal activity increases, resulting in considerable elevation of circulating levels of catecholamines. The ligation of the bead triggers an increase in the secretion of glucagon. While the plasma concentrations of glucose rapidly fall to insulin secretion decreases slowly. These adjustments, particularly the elevation of catecholamines stimulate glycogenolysis and gluconeogenesis in newborns. These mechanisms are relatively efficient in full-term newborns appropriate for gestational age, however are not as efficient in small for gestational age, preterm infants, large for gestational age, children of diabetic mothers and hiperinsulinemicos.there is not Yet a consensus to define the values of neonatal hypoglycemia, when we investigate and monitor, which the level and duration of hypoglycemia, which can lead to cerebral injuries and permanent sequelae. Various levels of blood glucose and glucose in plasma, based on screening of newborn infants or in clinical experience, have been recommended as values to define hypoglycemia. They are All something arbitrary, since it cannot be correlated with the rates of glucose utilization or the severity of symptoms. In practice, from the point of view the laboratory hypoglycemia can be defined as levels of plasma glucose less than 45 mg/dl or the total blood below 40 mg/dl in full-term newborns or premature and the clinical point of view with signs and symptoms present during low concentrations of glucose that improve when the blood glucose levels will normalize with treatment. The continuous monitoring of blood glucose levels was initially developed for the management of diabetes mellitus, promoting a better control of the disease. This form of measurement is also secure and reliable to be used in extremely low birth weight infants. However, this method has not yet been investigated in new-borns the term appropriate for gestational age. The continuous monitoring of the interstitial glucose is performed with a device that contains a disposable sensor that catalyzes the oxidation of glucose by generating an electrical current to every 10 seconds, that is recorded via cable on a small monitor. The monitor makes an average of the values for each 5 min giving a total of 288 measurements per day, which is considered continues. The proposal is the realization of a cross sectional observational study descriptive analytical. The group of patients will be composed of full-term newborns appropriate for gestational age in exclusive breastfeeding, infants of normal delivery or cesarean section. Will be included patients with weight equal to or above the 10th percentile for gestational age of 37 weeks (minimum weight of 2541 g) until newborns weighing less than or equal to the 90th percentile for gestational age of 42 weeks (maximum weight of 4098g). The criteria of non-inclusion / exclusion are: asphyxiated newborns with congenital malformations, large and small for gestational age, twins, children of diabetic mothers, with infections acquired or congenital, patients that are in use (or whose mothers use) of drugs that can interfere with the metabolism of glucose and patients with other diseases. The sample size shall be in accordance with convenience defined by the availability of equipment and time of internal (AU)