title: Cot-side electro-encephalography and interstitial glucose monitoring during insulin-induced hypoglycaemia in newborn lambs.
abstract: BACKGROUND
  The optimal approach to detection and management of neonatal hypoglycaemia remains unclear.
  
  
  OBJECTIVE
  We sought to demonstrate whether electro-encephalography (EEG) changes could be detected on the amplitude-integrated EEG monitor during induced hypoglycaemia in newborn lambs, and also to determine the accuracy of continuously measured interstitial glucose in this situation.
  
  
  METHODS
  Needle electrodes were placed in the P3-P4, O1-O2 montages. The interstitial glucose sensor was placed subcutaneously. After 30 min baseline recordings, hypoglycaemia was induced by insulin infusion and blood glucose levels were monitored every 5 min. The infusion was adjusted to reduce blood glucose levels by 0.5 mmol/l every 15 min and then maintain a blood glucose level <1.0 mmol/l for 4 h. EEG parameters analysed included amplitude, continuity and spectral edge frequency. The interstitial and blood glucose levels were compared.
  
  
  RESULTS
  All lambs (n = 15, aged 3-11 days) became hypoglycaemic, with median blood glucose levels falling from 6.5 to 1.0 mmol/l, p < 0.0001. There were no detectable changes in any of the measured EEG parameters related to hypoglycaemia, although seizures occurred in 2 lambs. There was moderate agreement between the intermittent blood glucose and continuous interstitial glucose measurements in the baseline, decline, and hypoglycaemia periods (mean difference -0.7 mmol/l, 95% confidence interval, CI, -2.8 to 1.4 mmol/l). However, agreement was poor during reversal of hypoglycaemia (mean difference 4.5 mmol/l, 95% CI -1.1 to 10.7 mmol/l).
  
  
  CONCLUSIONS
  The cot-side EEG may not be a useful clinical tool in the detection of neurological changes induced by hypoglycaemia. However, continuous interstitial glucose monitoring may be useful in the management of babies at risk of hypoglycaemia.
authors.affiliation: Newborn Intensive Care Unit, Waikato District Health Board, Hamilton, New Zealand.
authors.forename: Deborah L
authors.initials: DL
authors.lastname: Harris
authors.forename: Malcolm R
authors.initials: MR
authors.lastname: Battin
authors.forename: Chris E
authors.initials: CE
authors.lastname: Williams
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Weston
authors.forename: Jane E
authors.initials: JE
authors.lastname: Harding
mesh_terms: D000818:Animals; D000831:Animals, Newborn / Q000502:physiology*; D001786:Blood Glucose / Q000378:metabolism; D001921:Brain / Q000502:physiology; D004195:Disease Models, Animal; D004569:Electroencephalography; D045604:Extracellular Fluid / Q000378:metabolism*; D005947:Glucose / Q000378:metabolism*; D006339:Heart Rate / Q000502:physiology; D007003:Hypoglycemia / Q000139:chemically induced / Q000378:metabolism* / Q000503:physiopathology*; D007328:Insulin / Q000009:adverse effects; D012756:Sheep / Q000502:physiology*
chemical_list: D001786:Blood Glucose; D007328:Insulin; D005947:Glucose