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Letters |
Section of Clinical Chemistry, The PennState-Geisinger, Health System, The M.S. Hershey Medical Center, Hershey, PA 17033
a Author for correspondence.
To the Editor:
The ability to perform stat glucose testing in support of a neonatal intensive care unit has traditionally depended on transporting the sample to the central laboratory because most point-of-care glucose analyzers cannot accurately test glucose below 2.22 mmol/L (40 mg/dL). In addition, the high hematocrits commonly encountered in newborns and the high bilirubin concentrations often seen in the neonate can cause major problems with glucose measurements in whole blood. Most glucose meters are used for monitoring the diabetic; thus, their accuracy at low glucose concentrations has not been a prime consideration in their design.
The acute management of glucose homeostasis in the newborn is extremely
important to good patient care in the neonatal intensive care setting,
and the laboratory is frequently challenged to provide a more rapid and
sensitive means of determining blood glucose in the hypoglycemic infant
(1). Recently, several point-of-care testing
instruments have been developed that allow for on-site glucose testing
at the low end of the dynamic range of glucose measurements
(2). We recently evaluated the Precision-G System by
Medi-Sense, which can determine glucose on a 5-µL blood specimen
in 20 s at the bedside with a dynamic range that extends to 1.11
mmol/L (20 mg/dL). Seventy-four consecutive blood samples from the
neonatal unit were collected by heelstick into lithium heparin
capillary tubes, and glucose was determined simultaneously on an Ortho
Clinical Diagnostics Vitros 950 analyzer and the Precision-G System.
The neonatal population we studied demonstrated the usual range of
normal to high hematocrit values as well as increased bilirubin,
providing assurance that these variables did not influence the
results. Comparative results between these two methods are shown in
Fig. 1
.
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Regression analysis of the glucose values obtained with the Precision-G
and the Vitros 950 (Fig. 1
) revealed a correlation coefficient of 0.993
(Sy|x = 0.43 mmol/L), an intercept = -0.053
(± 0.002) mmol/L, and a slope of 0.946 (± 0.051). Although the number
of samples in the true hypoglycemic range was rather limited, the
results from 14 subjects with glucose results below 2.22 mmol/L (40
mg/dL) fell on the regression line. Overall, there was a slight
negative systematic difference observed with the Precision-G results
that averaged 0.31 mmol/L; differences in the analytical methods and
the use of whole blood vs plasma sample most likely account for this
difference. This slight difference, however, should have little
influence on the neonatologist's clinical decision regarding the
detection of hypoglycemia. Between-run imprecision (CV) with the
Precision-G using Abbott MediSense control material at 1.11
mmol/L (20 mg/dL) was 8% (n = 15). It is our
impression from these results that the Precision-G System can be used
effectively to determine low blood glucose concentrations in a neonatal
unit.
References
The following articles in journals at HighWire Press have cited this article:
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  S. Sadetzki, P. Flint-Richter, S. Starinsky, I. Novikov, Y. Lerman, B. Goldman, and E. Friedman Genotyping of Patients with Sporadic and Radiation-Associated Meningiomas Cancer Epidemiol. Biomarkers Prev., April 1, 2005; 14(4): 969 - 976. [Abstract] [Full Text] [PDF]
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