Desirée Balconara¹*, Salvatore Michele Carnazzo¹, Giusi Maria Caltabiano¹, Giovanni Cacciaguerra¹, Raffaele Falsaperla², Martino Ruggieri² and Tiziana Timpanaro²

¹Postgraduate Training Program in Pediatrics, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
²Department of Clinical and Experimental Medicine, University Hospital “Policlinico-San Marco”, Catania, Italy

*Corresponding Author: Desirée Balconara, Postgraduate Training Program in Pediatrics, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.

Received: June 08, 2022; Published: August 10, 2022

Abstract

Background: The role of continuous glucose monitoring (CGM) is widely recognized in the management of the diabetic patient, but is not routinely used to detect pediatric dumping syndrome, especially in infants admitted to NICU.

Aim: The purpose of this study is review systematically the available literature and point out the usefulness of continuous glucose monitoring in pediatric patients for the early interception of dumping syndrome, follow up and orienting therapeutic strategies, proposing the advantage in terms of reliability and tolerability compared to the heel glucose prick with glucometer and suggesting its application in NICU context.

Method: The search is carried on PubMed and Google Scholar database by screening all types of studies, with the keywords “continuous glucose monitoring", "CGM”, “pediatric dumping syndrome” and these exclusion criteria “ diabetes mellitus” “adult dumping syndrome”. We examinate all publications obtained from the search strategy and assessed the full text of studies potentially relevant for inclusion. Our search identified 9 eligible articles. Moreover, we report our case about a newborn affected by a congenital myasthenic syndrome presenting dumping syndrome.

Results: All the studies cited show the reliability of CGM in detecting glycemic fluctuations, compared to single and intermittent glucose samplings. Glycemic trends helped to adopt the best therapeutic strategy on a case-by-case basis.

Conclusions: Our paper strengthens the evidence on the usefulness of CGM in pediatric dumping syndrome, considering the outcomes reached in all 17 patients studied, in term of safety, reliability, non-invasiveness. Furthermore it suggests the potential future diffusion of this technology that is still little used routinely in NICU departments.

Keywords: Continuous Glucose Monitoring; CGM; Pediatric Dumping Syndrome

References

1. Meynaar IA., et al. “Blood glucose amplitude variability as predictor for mortality in surgical and medical intensive care unit patients: a multicenter cohort study”. Journal of Critical Care2 (2012): 119-124.
2. CJ McKinlay., et al. “Neonatal glycemia and neurodevelopmental outcomes at 2 years”. The New England Journal of Medicine 16 (2015): 1507-1518.
3. Meyer S., et al. “Infant dumping syndrome after gastroesophageal reflux surgery”. Journal of Pediatrics 99 (1981): 235-237.
4. Samuk I., et al. “Dumping syndrome following Nissen fundo-plication, diagnosis and treatment”. Journal of Pediatric Gastroenterology and Nutrition 23 (1996): 235-240.
5. Tack J., et al. “Pathophysiology, diagnosis and management of postoperative dumping syndrome”. Nature Reviews Gastroenterology and Hepatology 10 (2009): 583-590.
6. Vecht J., et al. “The dumping syndrome. Current insights into pathophysiology, diagnosis and treatment”. Scandinavian Journal of Gastroenterology 223 (1997): 21-27.
7. Mazze RS., et al. “Characterizing glucose exposure for individuals with normal glucose tolerance using continuous glucose monitoring and ambulatory glucose profile analysis”. Diabetes Technology and Therapeutics 10 (2008): 149-159.
8. Lang TF. “Update on investigating hypoglycaemia in childhood”. Annals of Clinical Biochemistry 48 (2011): 200-211.
9. Emidio Scarpellini., et al. “International consensus on the diagnosis and management of dumping syndrome”. Nature Reviews Endocrinology 16 (2020): 448-466.
10. van Beek AP., et al. “Dumping syndrome after esophageal, gastric or bariatric surgery: pathophysiology, diagnosis, and management”. Obesity Reviews1 (2017): 68-85.
11. Moher D., et al. “Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement”. BMJ 339 (2009): b2535.
12. Shea BJ., et al. “AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both”. BMJ 358 (2017): j4008.
13. Musthaffa YM., et al. “Dysregulated glucose homeostasis in congenital central hypoventilation syndrome”. Journal of Pediatric Endocrinology and Metabolism 12 (2018): 1325-1333.
14. Ueda K., et al. “Continuous glucose monitoring for suspected dumping syndrome in infants after Nissen fundoplication”. Pediatric International6 (2013): 782-785.
15. Tinti D., et al. “Fine tuning of nutritional therapy by using continuous glucose monitoring in an infant with a gastrointestinal malformation”. Acta Diabetology6 (2017): 607-609.
16. Bizzarri C., et al. “Dumping syndrome: an unusual cause of severe hyperinsulinemic hypoglycemia in neurologically impaired children with gastrostomy”. Minerva Pediatrics1 (2011): 67-71.
17. Morikawa M., et al. “Usefulness of Continuous Glucose Monitoring for Prevention and Early Detection of Hypoglycemia Caused by a Ketogenic Diet and Late Dumping Syndrome”. Pediatrics Neurology 105 (2020): 65-66.
18. Zung A and Zadik Z. “Acarbose treatment of infant dumping syndrome: extensive study of glucose dynamics and long-term follow-up”. Journal of Pediatric Endocrinology and Metabolism 6 (2003): 907-915.
19. Vukovic R., et al. “Postprandial hyperinsulinemic hypoglycemia in a child as a late complication of esophageal reconstruction”. Journal of Pediatric Endocrinology and Metabolism7 (2017): 791-795.
20. Singh E and Vella A. “Hypoglycemia after gastric bypass surgery”. Diabetes Spectrum 25 (2012): 217-221.
21. Chesser H., et al. “Continuous Glucose Monitoring to Diagnose Hypoglycemia Due to Late Dumping Syndrome in Children After Gastric Surgeries”. the Endocrine Society 3 (2021): bvaa197.
22. Calabria AC., et al. “Postoperative surveillance and detection of postprandial hypoglycemia after fundoplasty in children”. Journal of Pediatrics4 (2011): 597-601.e1.
23. Romeo DM., et al. “Neonatal neurological examination during the first 6h after birth”. Early Human Development 108 (2017): 41-44.
24. Galderisi A., et al. “Procedural Pain during Insertion of a Continuous Glucose Monitoring Device in Preterm Infants”. Journal of Pediatrics 200 (2018): 261-264.e1.
25. Marics G., et al. “Evaluation of an open access software for calculating glucose variability parameters of a continuous glucose monitoring system applied at pediatric intensive care unit”. BioMedical Engineering OnLine 14 (2015): 37.
26. TL Hernandez., et al. “Continuous glucose monitoring in the neonatal intensive care unit: not quite ready for ‘plug and play’”. Archives of Disease in Childhood. Fetal and Neonatal Edition 4 (2019): F344-F345.
27. Beardsall K. “Real time continuous glucose monitoring in neonatal intensive care”. Early Human Development 138 (2019): 104844.

Citation

Citation: Desirée Balconara., et al. “Reliability of Continuous Glucose Monitoring in the Management of Paediatric Dumping Syndrome: A Mini Systematic Review and Our NICU Case Report". Acta Scientific Paediatrics 5.9 (2022): 05-12.

Copyright

Copyright: © 2022 Desirée Balconara., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.