{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T19:52:57Z","timestamp":1792180377701,"version":"4.4.0"},"reference-count":58,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2022,9,29]],"date-time":"2022-09-29T00:00:00Z","timestamp":1664409600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"SFPREMAC 2021","award":["PR19721\/21"],"award-info":[{"award-number":["PR19721\/21"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antioxidants"],"abstract":"<jats:p>Glycemic variability (GV) is common in preterm infants. In the premature population, GV is a risk factor for morbidity and mortality. Both hypo- and hyperglycemia can impair neurodevelopment. We investigated the impact of continuous versus intermittent tube enteral feeding on GV. In our prospective observational study, 20 preterm infants with a gestational age \u2264 34 weeks at either continuous or intermittent bolus full enteral feeding. For five days, continuous glucose monitoring (CGM) was utilized, which was achieved through the subcutaneous insertion of a sensor. A total of 27,532 measurements of blood glucose were taken. The mean amplitude of glycemic excursions did not differ between the two cohorts statistically. Continuous feeding resulted in higher positive values, increasing the risk of hypo- and hyperglycemia. Subjects who were small for their gestational age had a higher standard deviation during continuous feeding (p = 0.001). Data suggest that intermittent bolus nutrition is better for glycemic control than continuous nutrition. Nutritional management optimization of preterm infants appears to be critical for long-term health. In the future, CGM may provide a better understanding of the optimal glucose targets for various clinical conditions, allowing for a more personalized approach to management.<\/jats:p>","DOI":"10.3390\/antiox11101945","type":"journal-article","created":{"date-parts":[[2022,9,29]],"date-time":"2022-09-29T04:09:36Z","timestamp":1664424576000},"page":"1945","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Continuous Glucose Monitoring in Preterm Infants: The Role of Nutritional Management in Minimizing Glycemic Variability"],"prefix":"10.3390","volume":"11","author":[{"given":"Valeria","family":"Musso","sequence":"first","affiliation":[{"name":"Pediatric and Neonatology Unit, Istituto Giannina Gaslini, 17100 Savona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6261-1128","authenticated-orcid":false,"given":"Isabella","family":"Panfoli","sequence":"additional","affiliation":[{"name":"Department of Pharmacy (DIFAR), University of Genoa, 16132 Genova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcella","family":"Battaglini","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genova, Italy"},{"name":"Neonatal Intensive Care Unit, Department Mother and Child, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8040-5950","authenticated-orcid":false,"given":"Giorgia","family":"Brigati","sequence":"additional","affiliation":[{"name":"Neonatal Intensive Care Unit, Department Mother and Child, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diego","family":"Minghetti","sequence":"additional","affiliation":[{"name":"Neonatal Intensive Care Unit, Department Mother and Child, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3883-0638","authenticated-orcid":false,"given":"Chiara","family":"Andreato","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genova, Italy"},{"name":"Neonatal Intensive Care Unit, Department Mother and Child, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca A.","family":"Ramenghi","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genova, Italy"},{"name":"Neonatal Intensive Care Unit, Department Mother and Child, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,9,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1055\/s-2000-7296","article-title":"Hypoglycemia: What is it for the neonate?","volume":"17","author":"Kalhan","year":"2000","journal-title":"Am. J. Perinatol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1016\/j.cnc.2018.07.004","article-title":"Neonatal hypoglycemia: Is there a sweet spot?","volume":"30","author":"Puchalski","year":"2018","journal-title":"Crit. Care Nurs. Clin. N. Am."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"972","DOI":"10.1001\/jamapediatrics.2017.1579","article-title":"Association of neonatal glycemia with neurodevelopmental outcomes at 4.5 years","volume":"171","author":"McKinlay","year":"2017","journal-title":"JAMA Pediatr."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1016\/j.clp.2006.10.001","article-title":"Glucose metabolism in the late preterm infant","volume":"33","author":"Garg","year":"2006","journal-title":"Clin. Perinatol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"634305","DOI":"10.3389\/fendo.2021.634305","article-title":"Neonatal hypoglycemia and brain vulnerability","volume":"12","author":"Brigati","year":"2021","journal-title":"Front. Endocrinol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1159\/000091948","article-title":"Hypoglycemia in newborn infants: Features associated with adverse outcomes","volume":"90","author":"Rozance","year":"2006","journal-title":"Biol. Neonate."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1016\/j.jpeds.2015.03.057","article-title":"Recommendations from the pediatric Endocrine Society for evaluation and management of persistent hypoglycemia in neonates, infants, and children","volume":"167","author":"Thornton","year":"2015","journal-title":"J. Pediatr."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e16","DOI":"10.1542\/pir.20.7.e16","article-title":"Neonatal hyperglycemia","volume":"20","author":"Hemachandra","year":"1999","journal-title":"Pediatr. Rev."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1811","DOI":"10.1542\/peds.2006-0628","article-title":"Hyperglycemia is a risk factor for early death and morbidity in extremely low birth-weight infants","volume":"118","author":"Hays","year":"2006","journal-title":"Pediatrics"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"641306","DOI":"10.3389\/fped.2021.641306","article-title":"Hyperglycaemia in the newborn infant. Physiology verses pathology","volume":"9","author":"Beardsall","year":"2021","journal-title":"Front. Pediatr."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1038\/pr.2012.184","article-title":"Hyperglycemia increases the risk of death in extremely preterm baboons","volume":"73","author":"Blanco","year":"2013","journal-title":"Pediatr. Res."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1542\/peds.113.3.537","article-title":"Both relative insulin resistance and defective islet beta-cell processing of proinsulin are responsible for transient hyperglycemia in extremely preterm infants","volume":"113","author":"Lahlou","year":"2004","journal-title":"Pediatrics"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1159\/000151643","article-title":"Strategies for feeding the preterm infant","volume":"94","author":"Hay","year":"2008","journal-title":"Neonatology"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2337","DOI":"10.1016\/j.clnu.2018.06.947","article-title":"ESPGHAN\/ESPEN\/ESPR\/CSPEN working group on pediatric parenteral nutrition. ESPGHAN\/ESPEN\/ESPR\/CSPEN guidelines on pediatric parenteral nutrition: Carbohydrates","volume":"37","author":"Mesotten","year":"2018","journal-title":"Clin. Nutr."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1094","DOI":"10.1177\/193229680800200618","article-title":"Glycemic variability: The third component of the dysglycemia in diabetes. Is it important? How to measure it?","volume":"2","author":"Monnier","year":"2008","journal-title":"J. Diabetes Sci. Technol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"838","DOI":"10.1097\/CCM.0b013e3181cc4be9","article-title":"Glucose variability is associated with intensive care unit mortality","volume":"38","author":"Hermanides","year":"2010","journal-title":"Crit. Care Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1122","DOI":"10.3109\/14767058.2011.624220","article-title":"Higher glycemic variability in very low birth weight newborns is associated with greater early neonatal mortality","volume":"25","author":"Fendler","year":"2012","journal-title":"J. Matern. Fetal Neonatal. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1186\/s12933-016-0427-0","article-title":"Acute blood glucose fluctuation enhances rat aorta endothelial cell apoptosis, oxidative stress and pro-inflammatory cytokine expression in vivo","volume":"15","author":"Wu","year":"2016","journal-title":"Cardiovasc. Diabetol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e20171162","DOI":"10.1542\/peds.2017-1162","article-title":"Continuous glucose monitoring in very preterm infants: A randomized controlled trial","volume":"140","author":"Galderisi","year":"2017","journal-title":"Pediatrics"},{"key":"ref_20","first-page":"F353","article-title":"Targeting glucose control in preterm infants: Pilot studies of continuous glucose monitoring","volume":"104","author":"Thomson","year":"2019","journal-title":"Arch. Dis. Child. Fetal Neonatal Ed."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1016\/j.jpeds.2018.03.040","article-title":"Procedural pain during insertion of a continuous glucose monitoring device in preterm infants","volume":"200","author":"Galderisi","year":"2018","journal-title":"J. Pediatr."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"18457","DOI":"10.1038\/s41598-021-98088-4","article-title":"Effects of early energy intake on neonatal cerebral growth of preterm newborn: An observational study","volume":"11","author":"Boscarino","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"158","DOI":"10.4081\/pmc.2017.158","article-title":"Feeding of preterm infants and fortification of breast milk","volume":"39","author":"Mangili","year":"2017","journal-title":"Pediatr. Med. Chir."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1097\/MCO.0000000000000447","article-title":"Intermittent versus continuous feeding in critically ill adults","volume":"21","author":"Patel","year":"2018","journal-title":"Curr. Opin. Clin. Nutr. Metab. Care"},{"key":"ref_25","first-page":"CD001819","article-title":"Continuous nasogastric milk feeding versus intermittent bolus milk feeding for premature infants less than 1500 grams","volume":"2011","author":"Premji","year":"2011","journal-title":"Cochrane Database Syst Rev."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1097\/MPG.0000000000000888","article-title":"Intermittent bolus or semicontinuous feeding for preterm infants?","volume":"61","author":"Maduro","year":"2015","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1016\/j.jpeds.2005.03.003","article-title":"Continuous feeding promotes gastrointestinal tolerance and growth in very low birth weight infants","volume":"147","author":"Dsilna","year":"2005","journal-title":"J. Pediatr."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1111\/j.1651-2227.1986.tb10280.x","article-title":"Gut hormones and \u2018minimal enteral feeding\u2019","volume":"75","author":"Lucas","year":"1986","journal-title":"Acta Paediatr. Scand."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1001\/archpedi.1987.04460040097025","article-title":"Enteral feeding in very-low-birth-weight infants. A comparison of two nasogastric methods","volume":"141","author":"Toce","year":"1987","journal-title":"Am. J. Dis Child."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1016\/S2352-4642(20)30367-9","article-title":"Real-time continuous glucose monitoring in preterm infants (REACT): An international, open-label, randomised controlled trial","volume":"5","author":"Beardsall","year":"2021","journal-title":"Lancet Child. Adolesc. Health"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Thoene, M., and Anderson-Berry, A. (2021). Early enteral feeding in preterm infants: A narrative review of the nutritional, metabolic, and developmental benefits. Nutrients, 13.","DOI":"10.3390\/nu13072289"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1111\/ped.12838","article-title":"Intraday glucose fluctuation is common in preterm infants receiving intermittent tube feeding","volume":"58","author":"Mizumoto","year":"2016","journal-title":"Pediatr. Int."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"F136","DOI":"10.1136\/archdischild-2012-301661","article-title":"Validation of the continuous glucose monitoring sensor in preterm infants","volume":"98","author":"Beardsall","year":"2013","journal-title":"Arch. Dis. Child. Fetal Neonatal. Ed."},{"key":"ref_34","first-page":"CD013309","article-title":"Continuous glucose monitoring for the prevention of morbidity and mortality in preterm infants","volume":"12","author":"Galderisi","year":"2021","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Uettwiller, F., Chemin, A., Bonnemaison, E., Favrais, G., Saliba, E., and Labarthe, F. (2015). Real-time continuous glucose monitoring reduces the duration of hypoglycemia episodes: A randomized trial in very low birth weight neonates. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0116255"},{"key":"ref_36","first-page":"67","article-title":"Impacts of Hypoglycemia in At-Risk Infants on Admissions to Level-3 Neonatal Units in a Tertiary-Care Hospital","volume":"11","author":"Alasaad","year":"2021","journal-title":"Res. Rep. Neonatol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1016\/j.jpeds.2010.02.003","article-title":"Continuous glucose monitoring in newborn babies at risk of hypoglycemia","volume":"157","author":"Harris","year":"2010","journal-title":"J. Pediatr."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"899","DOI":"10.3389\/fnins.2019.00899","article-title":"Early pain exposure influences functional brain connectivity in very preterm neonates","volume":"13","author":"Tortora","year":"2019","journal-title":"Front. Neurosci."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Ranger, M., Chau, C.M.Y., Garg, A., Woodward, T., Beg, M.F., Bjornson, B., Poskitt, K., Fitzpatrick, K., Synnes, A.R., and Miller, S. (2013). Neonatal pain-related stress predicts cortical thickness at age 7 years in children born very preterm. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0076702"},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Reddy, V.S., Agarwal, B., Ye, Z., Zhang, C., Roy, K., Chinnappan, A.l., Narayan, R.J., Ramakrishna, S., and Ghosh, R. (2022). Recent Advancement in Biofluid-Based Glucose Sensors Using Invasive, Minimally Invasive, and Non-Invasive Technologies: A Review. Nanomaterials, 12.","DOI":"10.3390\/nano12071082"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Ahmed, I., Jiang, N., Xinge Shao, X., Elsherif, M., Alam, F., Salih, A.E., Butt, H., and Yetisen, A.K. (2022). Recent advances in optical sensors for continuous glucose monitoring. Sens. Diagn.","DOI":"10.1039\/D1SD00030F"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"123187","DOI":"10.1016\/j.talanta.2021.123187","article-title":"Wearable hydrogel patch with noninvasive, electrochemical glucose sensor for natural sweat detection","volume":"241","author":"Lin","year":"2022","journal-title":"Talanta"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"e246","DOI":"10.1210\/clinem\/dgab601","article-title":"Continuous Glucose Monitoring in the Management of Neonates with Persistent Hypoglycemia and Congenital Hyperinsulinism","volume":"107","author":"Win","year":"2022","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1302","DOI":"10.1007\/s00125-022-05717-2","article-title":"Addition of intermittently scanned continuous glucose monitoring to standard care in a cohort of pregnant women with type 1 diabetes: Effect on glycaemic control and pregnancy outcomes","volume":"65","author":"Perea","year":"2022","journal-title":"Diabetologia"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1097\/MOP.0000000000000592","article-title":"Neonatal hypoglycemia: Continuous glucose monitoring","volume":"30","author":"Shah","year":"2018","journal-title":"Curr. Opin. Pediatr."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1089\/dia.2018.0168","article-title":"Defining glycemic variability in very low-birthweight infants: Data from a continuous glucose monitoring system","volume":"20","author":"Starzec","year":"2018","journal-title":"Diabetes Technol. Ther."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1016\/j.jpeds.2010.04.007","article-title":"Continuous glucose monitoring for diagnosis and treatment of neonatal hypoglycemia","volume":"157","author":"Hay","year":"2010","journal-title":"J. Pediatr."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1053\/sp.2000.6364","article-title":"Hypoglycemia in the neonate","volume":"24","author":"Cornblath","year":"2000","journal-title":"Semin. Perinatol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"e20161640","DOI":"10.1542\/peds.2016-1640","article-title":"Third Trimester Brain Growth in Preterm Infants Compared With In Utero Healthy Fetuses","volume":"138","author":"McCarter","year":"2016","journal-title":"Pediatrics."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"2268","DOI":"10.3109\/14767058.2013.796166","article-title":"Different gestational ages and changing vulnerability of the premature brain","volume":"28","author":"Sannia","year":"2015","journal-title":"J. Matern. Fetal Neonatal. Med."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"e584","DOI":"10.1542\/peds.2009-0449","article-title":"Early hyperglycemia is a risk factor for death and white matter reduction in preterm infants","volume":"125","author":"Alexandrou","year":"2010","journal-title":"Pediatrics"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1016\/j.jpeds.2017.05.052","article-title":"Relationship between measures of neonatal glycemia, neonatal illness, and 2-year outcomes in very preterm infants","volume":"188","author":"Tottman","year":"2017","journal-title":"J. Pediatr."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"104844","DOI":"10.1016\/j.earlhumdev.2019.104844","article-title":"Real time continuous glucose monitoring in neonatal intensive care","volume":"138","author":"Beardsall","year":"2019","journal-title":"Early Hum. Dev."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1681","DOI":"10.1001\/jama.295.14.1681","article-title":"Activation of oxidative stress by acute glucose fluctuations compared with sustained chronic hyperglycemia in patients with type 2 diabetes","volume":"295","author":"Monnier","year":"2006","journal-title":"JAMA"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"369","DOI":"10.3389\/fped.2018.00369","article-title":"Oxidative stress as a primary risk factor for brain damage in preterm newborns","volume":"6","author":"Panfoli","year":"2018","journal-title":"Front. Pediatr."},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Lembo, C., Buonocore, G., and Perrone, S. (2021). Oxidative stress in preterm newborns. Antioxidants, 10.","DOI":"10.3390\/antiox10111672"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"611","DOI":"10.4103\/2230-8210.113751","article-title":"Glycemic variability: Clinical implications","volume":"17","author":"Kota","year":"2013","journal-title":"Indian J. Endocrinol. Metab."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"153","DOI":"10.2174\/1573396318666220127155943","article-title":"Adenosine blood level: A biomarker of white matter damage in very low birth weight infants","volume":"18","author":"Colella","year":"2022","journal-title":"Curr. Pediatr. 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