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Hyperglycemia in newborns
Last reviewed: 23.04.2024
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[What causes hyperglycemia in newborns?
Hyperglycemia in newborns is often iatrogenic when too fast intravenous glucose is administered in the first few days of life in newborns with a very low birth weight (less than 1.5 kg). Another important cause is physiological stress in surgical interventions, hypoxia, respiratory distress syndrome or sepsis; A special risk is fungal sepsis. In preterm infants, a partial defect in the transformation of proinsulin into insulin and relative insulin resistance can cause hyperglycemia. In addition, transient diabetes mellitus in newborns is a rare cause, which is usually noted in small children by the time of gestation; administration of glucocorticoids can also lead to transient hyperglycemia. Hyperglycemia is less common than hypoglycemia, but it is equally important, as it increases morbidity and mortality in conditions that cause it.
Symptoms of hyperglycemia in newborns
Symptoms and manifestations correspond to the cause of hyperglycemia; the diagnosis is made on the basis of determining the level of glucose in the blood serum. Additional laboratory tests may include the determination of glucosuria and significant hyperosmolarity of the serum.
Treatment of hyperglycemia in newborns
Treatment of iatrogenic hyperglycemia is a reduction in glucose concentration in a solution for intravenous administration (eg, from 10 to 5%) or infusion rate; hyperglycemia persisting at a low rate of glucose infusion [eg, 4 mg / (kg min)) may indicate a relative insulin deficiency or insulin resistance. In the treatment of other causes, short-acting insulin is used. One approach is to add insulin to an intravenous infusion of a 10% glucose solution at a constant rate of 0.01 to 0.1 U / (kg h), then titrate the dose until the glucose level is normalized. Another approach is to administer insulin separately from intravenous infusion of a 10% glucose solution administered separately from the maintenance intravenous infusion, so that the administration of insulin can be controlled without changing the infusion rate. The answer to the introduction of insulin is unpredictable, and it is extremely important to monitor the level of glucose in the serum and carefully determine the rate of titration of insulin.
With transient diabetes mellitus, the level of glucose and hydration should be maintained until hyperglycemia is resolved spontaneously, usually for several weeks.
Any loss of fluids or electrolytes in osmotic diuresis should be reimbursed.