Непрерывный мониторинг гликемии у новорожденных: современные подходы, технологии и клиническое значение

Нарушения гомеостаза глюкозы — гипогликемия и гипергликемия относятся к наиболее частым метаболическим расстройствам неонатального периода и независимо связаны с риском неблагоприятных исходов нейропсихического развития. Распространение непрерывного мониторинга глюкозы (С6М, continuous glucose monitoring) меняет подходы к выявлению дисгликемии, однако его место в неонатологии до конца не определено.

Цель обзора. Обобщить современные данные о патофизиологии нарушений углеводного обмена у новорожденных, существующих критериях диагностики, методах прерывистого и непрерывного мониторинга глюкозы, а также о влиянии стратегий вскармливания и тактики ведения на ближайшие и отдаленные исходы.

Материалы и методы. Выполнен поиск публикаций в базах PubMed/Medline, Scopus, Cochrane Library, eLibrary за 2000-2025 гг. по ключевым словам: neonatal hypoglycemia, neonatal hyperglycemia, continuous glucose monitoring, preterm, feeding, neurodevelopment. В обзор включены клинические рекомендации (AAP, PES, ESPGHAN, проект клинических рекомендаций Российской Федерации 2024 г.), систематические обзоры, метаанализы, рандомизированные и когортные исследования, а также экспертные консенсусы.

Результаты. Пороговые значения глюкозы для диагностики гипогликемии варьируют между рекомендательными документами (2,2-2,6 ммоль/л у AAP, = 2,8 ммоль/л у PES в первые 48 часов жизни) и должны выбираться исходя из клинического контекста и возраста ребенка. Непрерывный мониторинг глюкозы в 2-8 раз увеличивает выявляемость гипогликемических эпизодов, преимущественно бессимптомных и ночных, сокращает суммарную продолжительность дисгликемии и при комбинации с алгоритмами поддержки принятия решений снижает вариабельность гликемии у глубоконедоношенных детей. Своевременное прикладывание к груди и контролируемое использование декстрозного геля сопоставимы с инфузией глюкозы по эффективности коррекции бессимптомной гипогликемии, при этом снижают частоту разлучения матери и ребенка. Сохраняются ограничения, связанные с точностью НМГ в зоне низких значений и недостатком данных РКИ о влиянии на отдаленные нейрокогнитивные исходы.

Заключение. Внедрение НМГ в практику неонатальных отделений рационально в группах высокого риска при условии валидации устройств, стандартизации алгоритмов реагирования и интеграции данных с клиническим решением. Дальнейшие исследования должны сфокусироваться на определении целевых диапазонов гликемии, оценке отдаленных исходов и экономической эффективности.

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