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Perinatal metabolism: impact on short term care and long term health.
The transition from fetal to independent life involves many adaptive processes in metabolism. Adaptation at this time has important impacts on both short term and long term health. In the NICU we try to control this environment to optimize the short term care but as yet do not fully understand the implications of what we do for long term health. At this time it is not uncommon for babies to have problems with glucose control. In the preterm infant the combination of hyperglycaemia, insulin deficiency and catabolism can be a challenge to manage clinically and may also have implications for both short and long term health. Interestingly babies born preterm, small for gestational age and large for gestational age are all at long term risk of impaired glucose tolerance which is a risk factor for type 2 diabetes. We are interested in exploring areas to improve our short term clinical management and investigating the long term impact on neurocognitive and metabolic outcomes of these babies.
Current Studies include:
Neonatal Intensive Care
Studies into the use of real time glucose monitoring to improve glucose control in preterm infants
Increasing numbers of preterm infants are born, with significant risk of mortality and morbidity. Treatments to improve outcomes have been difficult to identify. Both hyperglycaemia and hypoglycaemia are common in these babies, are difficult to manage, and have been linked with poor clinical outcomes. Management of glucose levels currently involves infrequent measurement of blood samples. In contrast many physiological parameters such as heart rate and oxygen saturations are monitored continuously. Patients with diabetes mellitus are cared for using devices that continuously monitor glucose levels (CGM). These devices provide the opportunity to monitor more closely and manage more accurately glucose levels in these babies. This has the potential to impact on both short term care and long term health.
Studies combining real time CGMS with computer algorithms to individualize the Real time CGMs device
We are using computer models that can stream the detailed information from rCGM to guide on going management. Therefore providing individualized management of glucose control for preterm our babies.
Cambridge baby growth study I
Examining the relative changes in body composition from birth to 2 years in small-for-gestational age infants and infants of diabetic mothers. This study will help to determine antenatal, postnatal dietary and genetic influences on growth as well as early biochemical markers (endocrine/metabolic markers) and immunological markers of changes in body composition.
SABS: Small at Birth Study
To determine what proportion of babies born small for gestational age (SGA) have shown catch up gains in weight at age 5-7 years and how many remain <2SD for height. To define the relative morbidity associated with being born SGA by assessment of the accumulation of different components of body composition (fat vs. lean mass) and different compartments of body fat (intra-abdominal vs. subcutaneous), as well as insulin secretion and sensitivity at age 5-7 years.
- Professor David Dunger
- Dr. Roman Hovorka
Collaborators outside this directory
- Isabel Iglesias
Beardsall K, Vanhaesebrouck S, Ogilvy-Stuart AL, Vanhole C, Vanweissenbruch M, Midgley P, Thio M, Cornette L, Ossuetta I, Palmer CR, Iglesias I, de Jong M, Gill B, de Zegher F, Dunger DB Validation of the continuous glucose monitoring sensor in preterm infants. Arch Dis Child Fetal Neonatal Ed. 2012 Jul 12
Beardsall K, Vanhaesebrouck S, Ogilvy-Stuart AL et al. Prevalence and determinants of hyperglycemia in very low birth weight infants: cohort analyses of the NIRTURE study. J Pediatr. 2010 Nov;157(5):715-9.
Beardsall K, Ong KK, Murphy N, Ahmed ML, Zhao JH, Peeters M, Dunger DB. Heritability of childhood weight gain from birth and risk markers for adult disease in pre-pubertal twins. J Clin Endocrinol Metab. 2009 Oct;94(10):3708-13.
BeardsallK, Vanhaesebrouck S, Vanhole C. et al. Prevention of hyperglycemia using early continuous insulin infusion during the first week of life does not improve short term mortality or morbidity in very low birth weight babies. The Neonatal Insulin Replacement Trial in Europe NIRTURE”. NEJM 2008 359 (18) 1873-84.
Beardsall K, Brocklehurst P and Ahluwalia JS. Should newborn infants be excluded from multiple research studies? Lancet 2008 372 (9637) 503-5.
Beardsall K, Ogilvy-Stuart AL, Ahluwalia J, Thompson M, Dunger DB The continuous glucose monitoring sensor in neonatal intensive care. Arch Dis Child Fetal Neonatal Ed. 2005 Jul;90(4):F307-10