背景:加拿大指南建议在无症状的“高危”婴儿(包括胎龄小[SGA]和胎龄大[LGA]婴儿)的2小时开始进行血糖(BG)筛查,干预截止值分别为1.8mmol/L和2.6mmol/L本研究对足月新生儿人群的这种做法进行了审查和审计。
方法:文献综述荟萃分析了适合胎龄(AGA)足月新生儿的BG值,以建立正常的1小时,2h和3h值。一项经临床审查审核的SGA和LGA足月新生儿筛查,评估临床负担和有效性。
结果:该综述包括六项研究,尽管没有明确定义血浆葡萄糖标准。2小时AGA婴儿的合并平均值(血浆)BG水平为3.35mmol/L(SD=0.77),显著高于1小时水平(3.01mmol/L,SD=0.96)。在审计中,78个SGA和142个LGA婴儿平均进行了6.0和4.7个BG测试,分别。SGA的平均2小时BG水平(3.42mmol/L,SD=1.02)和LGA(3.31mmol/L,SD=0.66)婴儿与AGA合并平均值没有显着差异。受试者工作特征曲线显示,LGA和SGA婴儿的2hBG水平可预测随后的低血糖(定义为BG水平低于2.6mmol/L),但是敏感性和特异性很差。
结论:发布的AGA婴儿2hBG水平高于1h值,与SGA和LGA婴儿的审核2h水平相似。临床上,2小时水平可预测后期低血糖,但可能需要重复BG测试。审计是验证国家准则的重要工具,最小化他们的负担,最大化他们的效用。
BACKGROUND: The Canadian
guidelines recommend blood glucose (BG) screening starting at 2 h of age in asymptomatic \'at-risk\' babies (including small-for-gestational-age [SGA] and large-for-gestational-age [LGA] infants), with intervention cut-offs of 1.8 mmol/L and 2.6 mmol/L. The present study reviews and audits this practice in full-term newborn populations.
METHODS: A literature review meta-analyzed BG values in appropriate-for-gestational age (AGA) term newborns to establish normal 1 h, 2 h and 3 h values. A clinical review audited screening of \'at-risk\' SGA and LGA term newborns, evaluating both clinical burden and validity.
RESULTS: The review included six studies, although none clearly defined the plasma glucose standard. The pooled mean (plasma) BG level in AGA babies 2 h of age was 3.35 mmol/L (SD=0.77), significantly higher than 1 h levels (3.01 mmol/L, SD=0.96). In the audit, 78 SGA and 142 LGA babies each had an average of 6.0 and 4.7 BG tests, respectively. The mean 2 h BG levels for SGA (3.42 mmol/L, SD=1.02) and LGA (3.31 mmol/L, SD=0.66) babies did not differ significantly from the AGA pooled mean. Receiver operating characteristic curves showed that 2 h BG levels in LGA and SGA babies predicted later hypoglycemia (defined as a BG level lower than 2.6 mmol/L), but sensitivities and specificities were poor.
CONCLUSIONS: Published 2 h BG levels for AGA babies are higher than 1 h values and are similar to audited 2 h levels in SGA and LGA babies. Clinically, 2 h levels are predictive of later hypoglycemia but may require repeat BG testing. Audit is an important tool to validate national
guidelines, to minimize their burden and to maximize their utility.