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Hyperglycemia in newborns
Last reviewed: 05.07.2025
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[ What causes hyperglycemia in newborns?
Hyperglycemia in neonates is often iatrogenic due to too rapid intravenous glucose administration in the first few days of life in very low birth weight infants (<1.5 kg). Another important cause is physiologic stress from surgery, hypoxia, respiratory distress syndrome, or sepsis; fungal sepsis is a particular risk. Inpremature infants, a partial defect in the conversion of proinsulin to insulin and relative insulin resistance may cause hyperglycemia. In addition, transient diabetes mellitus of the newborn is a rare cause that usually occurs in infants that are small for gestational age; glucocorticoid administration may also result in transient hyperglycemia. Hyperglycemia is less common than hypoglycemia but is no less important because it increases morbidity and mortality in the conditions that cause it.
Symptoms of hyperglycemia in newborns
Symptoms and signs are consistent with the cause of hyperglycemia; diagnosis is based on serum glucose measurement. Additional laboratory testing may include determination of glucosuria and significant serum hyperosmolarity.
Treatment of hyperglycemia in newborns
Treatment of iatrogenic hyperglycemia involves decreasing the intravenous glucose concentration (eg, from 10% to 5%) or the infusion rate; hyperglycemia that persists at low glucose infusion rates [eg, 4 mg/(kg min)] may indicate a relative lack of insulin or insulin resistance. For other causes, short-acting insulin is used. One approach is to add insulin to an intravenous infusion of 10% glucose at a constant rate of 0.01 to 0.1 U/(kg h), then titrate the dose until the glucose level is normal. Another approach is to give insulin separately from the intravenous infusion of 10% glucose, given separately from the intravenous maintenance infusion, so that insulin delivery can be adjusted without changing the infusion rate. The response to insulin is unpredictable, and it is essential to monitor serum glucose levels and carefully titrate the insulin.
In transient diabetes mellitus, glucose levels and hydration must be maintained until hyperglycemia resolves spontaneously, usually within a few weeks.
Any fluid or electrolyte losses due to osmotic diuresis should be replaced.