Glucose Regulation in Preterm Newborn Infants

Abstract

After birth, continuous transplacental transfer of glucose is interrupted. Neonates have to provide brain and vital organs with sufficient glucose. In term newborn infants, this is accomplished through well-coordinated hormonal and metabolic adaptive changes. During the first week of life, preterm infants are at high risk of abnormal glucose homeostasis. They are at risk of hypoglycemia due to limited glycogen and fat stores that should have occurred in the third trimester. Continuous glucose infusion is always required soon after birth to maintain the glucose level. However, under such conditions, many preterm infants develop hyperglycemia. Defective islet β-cell processing of proinsulin is likely related to hyperglycemia. There is also evidence that preterm infants are partially resistant to insulin. By contrast with adults, hepatic glucose production is not suppressed during parenteral glucose infusion. Exogenous insulin infusion partially reduces endogenous glucose production in preterm newborn infants. This treatment is efficient and safe when used with caution. More research is needed to understand the specificity of glucose homeostasis in preterm infants and to evaluate the long-term consequences of metabolic and nutritional support during early life.

Risk factors associated with hypoglycemia in neonates

“…Como se espera, los valores de glicemia capilar en los siguientes controles evidenciaron una tendencia en ascenso. Esto se debe a los mecanismos compensadores que se ponen en marcha una vez clampado el cordón ( 3 ) umbilical . La determinación de glicemia plasmática no es una prueba de rutina en el Servicio y no existen guías respecto a su indicación.…”

“…Muchos neonatos compensan esa "hipoglicemia fisiológica" con la producción de cuerpos cetónicos derivados de las grasas, como (2) fuente de energía . Pero si la hipoglicemia es persistente o recurrente y el RN presenta otros factores de riesgo, este imbalance del metabolismo (3,4) glucídico puede generar secuelas neurológicas .…”

“…Sí puso énfasis en identificar a los RN en riesgo de desarrollarla y las medidas profilácticas a (3,(5)(6)(7) aplicar .…”

Neonatal Hypoglycemia - Current Concepts

“…These free fatty acids play an important role as they promote further neoglucogenesis, and together with ketone bodies and lactate, are used as an alternative energy substrate for the brain. (Gustaffson, 2009;Mitanchez, 2007)) After birth, an adequate balance between tissue consumption of glucose, hepatic glucose production and exogenous glucose supply is necessary to establish glucose homeostasis. Glucose levels in the newborn decrease in the first two hours, but steadily rise afterwards and thereafter remain constant.…”

Carbohydrates metabolism disturbances when simulating prenatal alcohol intoxication

“…Довольно часто гипогликемия новорожденных является физиологическим состоянием и носит транзиторный характер. В основе развития транзиторной гипогликемии лежит высокая потребность в глюкозе у новорожденного, а также низкая активность ферментов, участвующих в реакциях глюконеогенеза [3]. Более длительный характер носят гипогликемии, причиной которых являются различные формы врожденного гиперинсулинизма [4].…”