Accuracy of neonatal venous blood glucose measurements using blood gas analyzer compared with central laboratory chemistry analyzer

Abstract

Background: Hypoglycemia is a serious problem in infants at risk and creates long-term consequences. Therefore, rapid and accurate measurement of blood glucose is of clinical importance. Objectives: The objective of this study was to evaluate the agreement of venous blood glucose measurements from hypoglycemic high-risk neonates, using blood gas analyzer (BGA), compared to central laboratory chemistry analyzer (CL). Methods: A prospective study of all high-risk neonates for hypoglycemia and neonatal intensive care units (NICUs) was enrolled. Point-of-care glucose was performed, and if <40 mg/dL, venous blood would be collected for CL and ABG. For analysis of the agreement of CL and BGA, Bland–Altman (BA) analysis, with multiple observations per individual, including limits of agreement (limits of agreement [LOA] ±1.96 standard deviation [SD]), was used. Results: One hundred and forty-five paired glucose values were analyzed. There were strong correlations between CL and BGA in all glucose measurements and hypoglycemic range (r = 0.81, P < 0.001, and 0.73, P < 0.01, respectively). A weak correlation was demonstrated in hyperglycemic ranges (r = 0.35, P = 0.15). For BA analysis of all glucose measurements and hypoglycemic ranges, LOA (±1.96 SD) of CL and BGA were −9.5 (±46.5) mg/dL and −11.1 (±10.9) mg/dL, respectively. The hyperglycemic range illustrated higher LOA, with LOA (±1.96 SD) of −32.9 (±124) mg/dL. Conclusions: In NICU settings where normoglycemic and hypoglycemic ranges are targeted, venous BGA glucose could be used as a reliable test instead of CL. No similar correlation was found in the hyperglycemic range.