Hyperglycaemia in the neonate
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Causes of Hyperglycaemia
- Immaturity of pancreatic function
- Insulin resistance
- Large glucose load
- Stress e.g. infection
- Side-effect of medication e.g. glucocorticoid therapy
Complications of Hyperglycaemia
- Associated with periventricular haemorrhage, retinopathy of prematurity and death
- Undernutrition leading to faltering growth
- Osmotic diuresis leading to dehydration
- Exacerbation of hypoxic ischaemic brain injury
Management of Hyperglycaemia
- Reduce glucose intake. For babies in the first 72 hours of life, or who are receiving a large volume of intravenous fluids, consider changing 10% glucose to 5% glucose
Criteria for insulin use: Persistent blood glucose concentration ≥ 10 mmol/L (If there is significant glycosuria ≥ 2+, check a blood glucose concentration)
Exceptions to insulin use: First 72 hours of life; acute transient stress e.g. post surgery, acute sepsis etc.
Management of Insulin Infusion
- Administer in same line as intravenous fluids, so if there are any interruptions, both are interrupted together
- Starting dose usually 0.05 units/kg/hr, then adjusted according to requirements
- Do not include insulin in the total daily fluid intake - it should be titrated on top of the prescribed fluid intake
- Monitor the blood glucose concentration, initially 2 hourly, and once stable at least 8 hourly
- Aim for a blood glucose concentration between 6 and 10 mmol/L
- Once the blood glucose concentration is stable within the target range, wean insulin dose at least daily, more often if tolerated
- Alsweiler JM, Harding JE, Bloomfield FH. Tight glycemic control with insulin in hyperglycemic preterm babies: a randomized controlled trial. Pediatrics. 2012;129(4):639-47.
- Collins JW, Hoppe M, Brown K, Edidin DV, Padbury J, Ogata ES. A controlled trial of insulin infusion and parenteral nutrition in extremely low birth weight infants with glucose intolerance. J Pediatr 1991; 118: 921-7.
- Beardsall K, Vanhaesebrouck S, Ogilvy-Stuart AL, Vanhole C, Palmer CR, van Weissenbruch M, et al. Early insulin therapy in very-low-birth-weight infants. N Engl J Med. 2008;359(18):1873-84.
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- Date last published: 01 April 2013
- Document type: Clinical Guideline
- Services responsible: Neonatology
- Author(s): Jane Alsweiler
- Owner: Newborn Services Clinical Practice Committee
- Editor: Sarah Bellhouse
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