title: Lactate, rather than ketones, may provide alternative cerebral fuel in hypoglycaemic newborns.
abstract: OBJECTIVE
  Alternative cerebral fuels are reputed to provide neuroprotection during hypoglycaemia, particularly in breastfed babies. We measured concentrations of alternative cerebral fuels in hypoglycaemic babies in the first 48 h.
  
  
  METHODS
  Babies were ≥35 weeks, ≤48 h old and at risk of hypoglycaemia (infant of diabetic, preterm, small or large). Plasma glucose, β-hydroxybutyrate, lactate and insulin concentrations were measured in babies who had been hypoglycaemic (<2.6 mM) for >1 h.
  
  
  RESULTS
  Samples were taken from 35 hypoglycaemic babies at 3.7; 1.8-39.6 (median; range) hours after birth. Concentrations of glucose and β-hydroxybutyrate were low (2.03; 0.19-3.39 mM and 0.06; 0.00-1.20 mM), but lactate concentrations varied widely (3.06; 0.02-7.96 mM). Infants of diabetics had lower β-hydroxybutyrate and higher insulin concentrations, but mode of feeding did not influence plasma concentrations of alternative cerebral fuels.
  
  
  CONCLUSIONS
  Hypoglycaemic babies within the first 48 h after birth are unlikely to receive neuroprotection from ketones. However, lactate may provide an alternative cerebral fuel for many. Lactate, rather than ketones, may provide alternative cerebral fuel in hypoglycaemic newborns.
  
  
  BACKGROUND
  ACTRN12608000623392.
authors.affiliation: Newborn Intensive Care Unit, Waikato District Health Board, Hamilton, New Zealand Liggins Institute, University of Auckland, Auckland, New Zealand.
authors.forename: Deborah L
authors.initials: DL
authors.lastname: Harris
authors.affiliation: Newborn Intensive Care Unit, Waikato District Health Board, Hamilton, New Zealand.
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Weston
authors.affiliation: Liggins Institute, University of Auckland, Auckland, New Zealand.
authors.forename: Jane E
authors.initials: JE
authors.lastname: Harding
mesh_terms: D020155:3-Hydroxybutyric Acid / Q000097:blood; D015415:Biomarkers / Q000097:blood; D001724:Birth Weight; D001786:Blood Glucose / Q000032:analysis; D001942:Breast Feeding; D004311:Double-Blind Method; D005260:Female; D005865:Gestational Age; D005947:Glucose / Q000627:therapeutic use; D006801:Humans; D007003:Hypoglycemia / Q000097:blood* / Q000188:drug therapy / Q000209:etiology; D007231:Infant, Newborn; D007328:Insulin / Q000097:blood; D007659:Ketones / Q000097:blood*; D019344:Lactic Acid / Q000097:blood*; D008297:Male; D011247:Pregnancy; D011254:Pregnancy in Diabetics; D011297:Prenatal Exposure Delayed Effects; D011379:Prognosis; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D007328:Insulin; D007659:Ketones; D019344:Lactic Acid; D005947:Glucose; D020155:3-Hydroxybutyric Acid
keywords: Endocrinology; Neonatology