Neonatal Hyperglycemia

Definition
Hyperglycemia

generally is defined as plasma glucose concentration greater than 8.05 to 8.33 mmol/L regardless of the neonates gestational age or weight

Signs
dehydration

diuresis weight loss failure to thrive fever glycosuria ketosis metabolic acidosis. Mostly asymptomatic

-osmotic

Etiology
1)Glucose infusion 2)Lipids 3)Stress 4)Insulin dependent DM 5)Others-drugs

Glucose infusion
high

rates of exogenous glucose given to preterm neonates in infusions and TPN exceeding the endogenous rates of glucose production (4-8mg/kg/min) Formula for calculating glucose infusion rate: Mg/kg/min = %dextrose x rate/wtx6

Lipids
Increased

plasma free fatty acid concentrations

Decrease peripheral glucose utilization inhibit the effect of insulin to suppress hepatic glucose production.

Stress
Stress

due to

Disease process Medical intervention Surgical intervention

During

stress there is release of epinephrine,glucocorticoids and glucagon.

 Epinephrine

decreases insulin secretion from the pancreatic beta cell and interferes with peripheral insulin action. Glucagon promotes glycogenolysis and release of hepatic glucose. Glucocorticoids also enhance hepatic enzyme activity in the gluconeogenic pathway, which releases glucose into the circulation.

Insulin Dependent DM
Transient

neonatal diabetes mellitus (TNDM) presents early in postnatal life-Cpeptide and plasma insulin are low A rebound in C-peptide concentration typically marks the resolution.

 If

it doesnt resolve it indicates permanent neonatal DM endogenous insulin deficiency due to failure of pancreatic beta cells

drugs
Theopylline

Dexamathasone
Prostaglandin

Complications
Dehydration-osmotic

diuresis Intraventricular hemorrhage -increase serum osmolarity -rapid shifting of water Ischemic events-brain -hyperosmolarity -lactic acidosis -decrease regional cerebral blood flow

 Steatosis-impairment

of triglycerides

of hepatic secretions

Due to aggressive glucose administrations

Prolonged

ventilation -lipogenesis causes increase co2 -increase need for ventilation-LBW/ELBW

 Electrolyte

imbalance

-infants with glycosuriaincrease in sodium excretion -due to increase filtered sodium load

Aims of treatment
Identify

underlying etiology Prevent complications Administer continous insulin infusionsafely to maintain euglycemia and adequate calorie intake

Management
RBS-confirmation

Monitor

urine for glycosuria and urine volume (mL/kg/hr) to ensure adequate fluid balance If baby needs additional fluids to counter renal and extrarenal losses (phototherapy) consider using 5% dextrose or 0.45% saline

 Seek

and treat serious underlying disorders especially infection (septic screen and antibiotics). Achieve adequate sedation and pain relief Calculate glucose delivery rate
More than 10mg/kg/min-reduce to 610mg/kg/min

 If

hyperglycemia still persist-consider insulin sliding scale -0.02unit/kg to 0.05unit/kg per hour Enteral feeding-promotes pancreatic function and secretion of insulin Hypocount monitored 2-4 hourly-prevent hypoglycemia