Continuous Glucose Monitoring in At-Risk Newborns
Continuous Glucose Monitoring in At-Risk Newborns
Hypoglycemia (low blood glucose) is a very common problem in newborns, and has been
 associated with poor neurodevelopment, cognition, and school performance. At-risk newborns
 (infants of diabetic mothers [IDM], large [LGA] and small [SGA] for gestational age infants,
 and late preterm [LPT] infants) undergo a hypoglycemia screening protocol that involves
 numerous intermittent needle sticks to test glucose levels on bedside glucometers; however,
 continuous glucose monitoring (CGM, currently not approved for clinical use in babies), via a
 small sensor placed in the thigh (only 1 needle stick), would likely decrease pain while
 providing continuous glucose levels. This study will evaluate the feasibility, safety, and
 precision of CGM in at-risk newborns, and determine if this method would decrease the amount
 of painful procedures and episodes of hypoglycemia missed by intermittent sampling.

 As part of regular medical care, participants will undergo intermittent blood glucose
 screening with heel sticks as per the current hospital standard of care protocol. Regular
 medical care involves checking the participant's blood glucose via heel stick every few hours
 using a bedside glucometer, with another heel stick to confirm low values in the laboratory.
 If the participant has low values, he/she may be treated with oral glucose gel, feedings of
 breast milk or formula, or intravenous (IV) fluids in the Neonatal Intensive Care Unit
 (NICU). This research study involves placing a CGM device in addition to undergoing the
 current blood glucose screening protocol and treatment.

 As soon as possible after birth, a continuous glucose monitoring device (Dexcom G6) will be
 placed on the participant's thigh by a research team member, and will blindly continuously
 record glucose levels that will be analyzed after discharge. Everyone who agrees to
 participate in this study will have placement of this experimental device.

 The investigational device will stay in place for the same amount of time that a participant
 is undergoing blood glucose monitoring as per the current standard of care protocol, for a
 maximum of 7 days. A participant may need to have his/her blood glucose checked after 7 days
 for regular medical care (and not for research), because his/her glucose concentrations are
 still low. Being in the research study will not affect a participant's medical care, and will
 not affect how long he/she needs blood glucose monitoring or treatment.

 A research team member will place and remove the CGM. Nurses will evaluate the site of the
 device for signs of irritation, infection, bleeding, and any other issues at least 3 times
 per day. After discharge from the hospital, data will be collected from the participant's
 medical record and participant's mother's medical record, including the participant's sex and
 birth weight, blood glucose values, details of feedings, treatments given for low glucose
 concentrations, and NICU admission data. Data that will be collected from the participant's
 mother's medical record includes age and race, prenatal data, medical history, and medication
 use. The participant's parents will be asked to fill out a short survey about their
 experience with this device when it is removed.
Inclusion Criteria:

 -  At-risk newborns (<48 hours old, all sexes) admitted to the Newborn Nursery or the
 NICU who meet any of the below criteria:

 1. Infant of a diabetic mother (IDM, pre-existing or gestational diabetes)

 2. Large for gestational age (LGA, >90th percentile [sex-specific])

 3. Small for gestational age (SGA, <10th percentile [sex-specific])

 4. Late preterm (LPT, 34 0/7 to 36 6/7 weeks' gestation)

 -  Any newborn undergoing routine blood glucose screening in the newborn nursery per the
 Neonatal Hypoglycemia protocol (includes newborns of mothers taking oral hypoglycemic
 agents, beta-blocker medications, or systemic steroids within 7 days before delivery;
 and newborns with clinical manifestations of hypoglycemia)

 Exclusion Criteria:

 -  Birth weight <2kg

 -  hypoxic-ischemic encephalopathy

 -  a contraindication to oral feeding

 -  abnormal skin that will preclude placement of the CGM (e.g., skin on the thigh that is
 not intact)

 -  chromosomal abnormalities or severe congenital anomalies identified ante- or
 postnatally

 -  infants who are not expected to survive or who are in extremis

 -  additional risk of immunocompromise, including:

 1. Skin infections, such as staphylococcus or streptococcus skin infections and
 herpes (skin, eye, and mouth disease) infection

 2. Skin diseases that add additional risk, such as epidermolysis bullosa,
 ichthyosis, peeling skin syndrome, and hemangiomas

 3. Systemic sepsis, viral syndromes

 4. Immune diseases such as severe combined immunodeficiency, cancer, T-cell or
 B-cell deficiencies, inborn errors of metabolism, chromosomal abnormalities,
 glycogen storage diseases, genetic diseases

 5. Abdominal wall defects