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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

  1. 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
  2. Insulin 
    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

  1. Administer in same line as intravenous fluids, so if there are any interruptions, both are interrupted together 
  2. Starting dose usually 0.05 units/kg/hr, then adjusted according to requirements 
  3. Do not include insulin in the total daily fluid intake - it should be titrated on top of the prescribed fluid intake 
  4. Monitor the blood glucose concentration, initially 2 hourly, and once stable at least 8 hourly 
  5. Aim for a blood glucose concentration between 6 and 10 mmol/L 
  6. Once the blood glucose concentration is stable within the target range, wean insulin dose at least daily, more often if tolerated 

References

  1. 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. 
  2. 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. 
  3. 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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Document Control

  • 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