Hyperglycaemia in the Newborn Infant. Physiology Verses Pathology

Abstract

Hyperglycemia is common in newborns requiring intensive care, particularly in preterm infants, in sepsis and following perinatal hypoxia. The clinical significance, and optimal intervention strategy varies with context, but hyperglycaemia is associated with increased mortality and morbidity. The limited evidence for optimal clinical targets mean controversy remains regarding thresholds for intervention, and management strategies. The first consideration in the management of hyperglycaemia must be to ascertain potentially treatable causes. Calculation of the glucose infusion rate (GIR) to insure this is not excessive, is critical but the use of insulin is often helpful in the extremely preterm infant, but is associated with an increased risk of hypoglycaemia. The use of continuous glucose monitoring (CGM) has recently been demonstrated to be helpful in targeting glucose control, and reducing the risk from hypoglycaemia in the preterm infant. Its use in other at risk infants remains to be explored, and further studies are needed to provide a better understanding of the optimal glucose targets for different clinical conditions. In the future the combination of CGM and advances in computer algorithms, to provide intelligent closed loop systems, could allow a safer and more personalized approached to management.

Neonatal Hyperglycemia and Neurodevelopmental Outcomes in Preterm Infants: A Review

“…Preterm infants have a high risk of hyperglycemia [ 13 ]. In early childhood—1–5 years CA—neonatal hyperglycemia is associated with neurodevelopmental impairment in preterm infants, especially with respect to the motor domain.…”

“…Moreover, enteral feeding is often delayed in preterm infants, meaning a low production of incretins—the hormones that stimulate insulin secretion [ 12 ]. Frequently preterm infants need intravenous glucose infusion but, unlike adults, the endogenous glucose production is not suppressed: this may be derived from both an immature expression of GLUT2 in the liver that causes continuous hepatic glucose production, and a reduced glucose uptake by insulin-sensitive tissue, such as adipose and skeletal muscle, which have a lower GLUT4 [ 13 ] expression. This relative insulin resistance may be worsened by increased proinflammatory cytokines, for example due to sepsis, increased counter-regulatory hormones associated to stress—such as epinephrine and cortisol—and intensive care intervention, with the use of inotropes and corticosteroids [ 14 ].…”

Insulin for Treatment of Neonatal Hyperglycemia in Premature Infants: Prevalence over Time and Association with Outcomes

“…The median PNA at first administration of insulin was 2 days (1-7). The median PNA at discontinuation of insulin therapy was 7 days (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14), and the median total duration of insulin treatment was 2 days (1-6). Infants exposed to insulin had a greater median PMA at discharge (39.3 weeks (37.4-41.9) vs 38.0 weeks (36.3-40.3); p <0.001).…”

Safety and Quality of Intravenous Lipids for Newborns: Effects on Critical Diseases and Metabolic Disorders (Part Ii)

“…Клінічне значення та оптимальна стратегія втручання залежать від контексту, але гіперглікемія пов'язана з підвищенням смертності та захворюваності. У немовлят з ЕММТ, які отримують навіть 3-4 мг/кг/хв інфузії глюкози, приблизно у 80% випадків розвинулась гіперглікемія вище 8 ммоль/л, та в подальшому у 57% немовлят -вище 10 ммоль/л [16]. Чинники гіперглікемії можуть бути пов'язані зі зниженням периферичної утилізації глюкози (периферична непереносимість глюкози) та/або інгібуванням дії інсуліну через гальмування вироблення глюкози печінкою (центральна інсулінорезистентність).…”