日本新生児成育医学会雑誌　第28巻　第2号　57～62頁（2016年）

日本新生児成育医学会雑誌 28(2)：281-286；2016　

受付日：平成27．10．16

受理日：平成28．03．25

NICU/GCU における持続血糖測定システム（CGM）の有用性に関する検討
（第2報）：新生児一過性高インスリン血症性低血糖症管理におけるCGM

A Study of the Utility of Continuous Glucose Monitoring（ CGM） in the NICU：the 2nd Report；in Neonatal Transient Hyperinsulinemic Hypoglycemia

武蔵野赤十字病院　新生児内科

Department of Neonatal Medicine, Musashino Red Cross Hospital

中村利彦・野村智章・畠中大輔・草苅倫子・高橋秀弘・蒲原　孝

Toshihiko NAKAMURA，Tomoaki NOMURA，Daisuke HATANAKA，Michiko KUSAKARI，Hidehiro TAKAHASHI，Takashi KAMOHARA

Key Words：continuous glucose monitoring（CGM），glycemic variability，neonates，
transient neonatal hyperinsulinemic hypoglycemia（TNHI）

　新生児一過性高インスリン血症性低血糖と診断した3 例を対象として，持続血糖測定（continuous glucose monitoring：CGM）を行った。高濃度ブドウ糖液による補液で血糖値を安定させた後，補液漸減，経腸栄養漸増中の時期（第1回CGM：急性期）と，完全経腸栄養が確立した時期（第2回CGM：安定期）の2期でCGMを施行して比較をした。授乳から次の授乳までの1 区間における最高血糖値と最低血糖値の差を「授乳区間血糖変動幅」として症例毎の2点で比較すると，安定期の方が有意に大きかった。また，完全経腸栄養時には低血糖の再燃はなかった。前回の授乳間隔延長に伴う「授乳区間血糖変動幅」の推移に加え，一過性高インスリン血症性低血糖における治療の経過で「授乳区間血糖変動幅」の推移をCGM で観察することは，児の耐糖能獲得の確立を判定する上で有用であることが示唆された。

Patients and Method：For three newborn babies, two late preterm infants and one completing term, with transient hyperinsulinemic hypoglycemia, continuous glucose monitoring （CGM） was performed and serial changes in blood glucose level monitored. The CGMs were conducted twice for three days each. The first monitoring was several days after the diagnosis of hyperinsulinemic hypoglycemia and the second monitoring was at the time enteral feeding had been completely established. We calculated the difference between the maximum and minimum blood glucose levels in the area between the wards from the time of feeding to the next feeding and named this variable “glucose variability between feedings”.
Results：Having compared “glucose variability between feedings” in each patient, the variability during the second monitoring increased more significantly compared with the first monitoring. There were no hypoglycemic records that lasted throughout each CGM.
Discussion：Because the blood glucose levels of patients with transient neonatal hyperinsulinemic hypoglycemia were sluggish due to inappropriate secretion of endogenous insulin during the early neonatal period, “glucose variability between feedings” was also low. It was therefore suggested that “glucose variability between feedings” would increase significantly when endogenous insulin secretion is appropriate. CGM was confirmed as playing a beneficial role in managing hypoglycemia and evaluating the establishment of insulin secretion in patients with neonatal transient hyperinsulinemic hypoglycemia.