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Master's Dissertation
DOI
Document
Author
Full name
Nathália Azevedo
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
Ribeirão Preto, 2019
Supervisor
Committee
Liberatore Junior, Raphael Del Roio (President)
Marba, Sergio Tadeu Martins
Almeida, Maria Fernanda Branco de
Ferri, Walusa Assad Gonçalves
Title in Portuguese
Análise de 24 horas dos valores de glicemia intersticial invasiva em recém-nascidos a termo, adequados para idade gestacional
Keywords in Portuguese
Doenças do recém-nascido
Glicemia
Hipoglicemia
Abstract in Portuguese
Os valores de glicemia considerados fisiológicos em recém-nascidos, assim como os valores considerados patológicos, levando a danos no sistema neurológico, são bastante debatidos na literatura e há pouco consenso. O objetivo deste trabalho foi analisar a glicemia de 172 recém-nascidos adequados para a idade gestacional, a termo e em aleitamento materno exclusivo, no primeiro dia de vida, através de monitor contínuo de glicemia intersticial, que registra a glicemia a cada 5 minutos. O aparelho foi retirado após 24 horas e os resultados foram analisados em programa de computador. A amostra apresentou glicemia média de 66,6 mg/dl logo após o nascimento, com redução até a sexta hora de vida, com o valor de 53,7 mg/dl. Apenas na decima quarta hora de vida, a glicemia voltou a atingir valores entre 60 e 70 mg/dl. A média da glicemia dos recém-nascidos, durante o primeiro dia de vida, foi de 60,1 mg/dl (+/- 8,3). Da amostra, 63,9% apresentou uma ou mais medidas iguais ou menores que 50 mg/dl, 16,3% apresentou uma ou mais medidas iguais ou menores que 40 mg/dl; 4,6% apresentou uma ou mais medidas iguais ou menores que 30 mg/dl e 1,2% apresentou uma ou mais medidas iguais ou menores que 20 mg/dl. Os resultados mostraram um padrão de glicemia para essa casuística, com glicemia que cai rapidamente do nascimento até a sexta hora de vida e volta a subir até a decima quinta hora, ao atingir um valor que permanece estável até o final do dia. Este estudo permitiu elaborar uma curva de evolução dos valores de glicemia intersticial, com média e dois desvios padrões acima e abaixo. A porcentagem de recém-nascidos com a glicemia igual ou abaixo de 40 mg/dl, nesse estudo, comparada a outros estudos utilizando dosagem intermitente, mostrou que a monitorização contínua é capaz de detectar maior ocorrência de valores abaixo de 40 mg/dl. Recém-nascidos com valores de glicemia igual ou abaixo de 30 mg/dl estão abaixo da curva de normalidade traçada nesse estudo e devem, posteriormente, serem estudados em estudo prospectivo. A curva de evolução dos valores de glicemia pode contribuir para o estabelecimento de padrão de valoresglicêmicos durante as primeiras 24 horas de vida em recém-nascidos nascidos a termo, adequados a idade gestacional e sem agravos no período neonatal.
Title in English
24-hour analysis of invasive interstitial glycemic values in term newborns, appropriate for gestational age
Keywords in English
Blood glucose
Diseases
Hypoglycemia
Infant
Newborn
Abstract in English
The values of glycemia that are considered physiological in neonates, as well as those considered pathological (that is, leading to damages in the neurological system) are widely debated in literature, and there is little consensus. The objective of this study was to analyze the glycemia of 172 appropriate for gestational age term newborns, who were exclusively breastfed, on the first day of life, through a continuous glucose monitoring device, which calculates interstitial glycemia every 5 minutes. The device was removed after 24 hours, and the results were analyzed in a computer program. The sample had a mean glycemia of 66.6 mg/dl shortly after birth, with a reduction until 6 hours of life, reaching a value of 53.7 mg/dl. At only 14 hours of life, the blood glucose returned to values between 60 and 70 mg/dl. The mean blood glucose of the newborns during the first day of life was 60.1 mg/dl (+/- 8.3). 63.9% of the sample had one or more values of glycemia equal to or lower than 50 mg/dl, 16.3% had one or more values equal to or lower than 40 mg/dl. 4.6% had one or more values equal to or lower than 30 mg/dl and 1.2% had one or more values equal to or lower than 20 mg/dl. The results present the glycemia pattern considered physiological for this sample, with glycemia that falls rapidly from birth up to 6 hours of life and goes back up to 15 hours, reaching a value that remains stable until the end of the first day. This study allowed the development of an evolution curve of interstitial glycemia values, with mean and two standard deviations above and below it. The percentage of newborns with glycemia at or below 40mg/dl in this study, compared to other studies using intermittent dosing, showed that continuous monitoring is able to detect a higher occurrence of values below 40 mg/dl. Newborns with blood glucose values equal to or lower than 30 mg/dl are below the normality curve plotted in this study and should be further studied in a prospective study. The evolution curve of the glycemia values may contribute to the establishment of glycemic values during the first 24 hours of life in term newborns who are appropriate for gestational age and didn't present any conditions in the neonatal period.
 
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Publishing Date
2019-08-07
 
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