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Neonatal hyperglycemia

INTRODUCTION

Glucose supply and metabolism are of central importance for growth and normal brain development in the fetus and newborn. Disorders in glucose supply or metabolism can result in hypoglycemia or hyperglycemia. Hyperglycemia in the neonatal period is reviewed here. Neonatal hypoglycemia is discussed separately. (See "Neonatal hypoglycemia".)

PARENTERAL GLUCOSE

Most infants who are preterm or ill require parenteral administration of glucose because adequate enteral feeding is delayed. Neonatal hyperglycemia often occurs in this setting.

Immediately after birth, sufficient glucose is provided to avoid hypoglycemia, typically at a rate of 5 to 8 mg/kg per minute. As an example, administration of 10 percent dextrose solution at 100 mL/kg per day provides glucose at a rate of 7 mg/kg per minute. Although dextrose is a hydrated form of glucose and is 91 percent glucose, the correction usually is not applied in clinical practice.

The glucose infusion rate is increased to approximately 11 to 12 mg/kg per minute in the first two to three days after birth to provide calories for growth. In general, glucose infusion rates >15 mg/kg per minute are avoided, as this exceeds the ability of most infants to oxidize glucose and may promote excessive lipogenesis. (See "Parenteral nutrition in premature infants", section on 'Glucose'.)

DEFINITION

The definition of hyperglycemia is uncertain. It is often defined as blood glucose >125 mg/dL (6.9 mmol/L) or plasma glucose >150 mg/dL (8.3 mmol/L). These glucose levels are frequently observed during glucose infusions in newborns, especially in extremely preterm infants, and may not require intervention [1].

                      

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Literature review current through: Nov 2014. | This topic last updated: Aug 7, 2013.
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