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Neonatal energy substrate production
1Department of Women's & Children's Health, Uppsala University, Uppsala, Sweden. jan.gustafsson@kbh.uu.se
Insights
Newborn infants can produce glucose shortly after birth, even extremely premature ones. This glucose production, along with fat breakdown (lipolysis), is crucial for energy, especially for the brain.
Area of Science:
- Neonatal physiology
- Metabolic adaptation
- Endocrinology
Background:
- Glucose is the primary fetal energy source, necessitating endogenous production by newborns post-birth.
- Neonatal hypoglycemia affects high-risk infants, including premature, low birth weight, and those born to diabetic mothers or large for gestational age.
- Infants born large for gestational age face increased risks of metabolic disease later in life.
Purpose of the Study:
- To investigate the capacity for endogenous glucose production and lipolysis in specific neonatal risk groups.
- To explore compensatory mechanisms in infants of diabetic mothers and infants born large for gestational age.
- To understand the relationship between maternal factors and fetal growth concerning neonatal metabolism.
Main Methods:
- Analysis of endogenous glucose production in extremely premature infants during the first postnatal day.
- Assessment of lipolysis capacity in infants of diabetic mothers and infants born large for gestational age.
- Correlation of fetal weight and maternal parameters (e.g., fat mass) with neonatal metabolic status.
Main Results:
- Extremely premature infants demonstrate glucose production capacity on day one, despite limited fat stores.
- Infants of diabetic mothers exhibit unimpaired lipolysis, potentially compensating for reduced glucose production.
- Infants born large for gestational age show high lipolysis rates and reduced insulin sensitivity early in life, linked to maternal factors.
Conclusions:
- Neonatal endogenous glucose production and lipolysis are vital for metabolic adaptation immediately after birth.
- Specific risk groups exhibit unique metabolic profiles and compensatory strategies.
- Maternal factors significantly influence fetal growth and neonatal metabolic health, highlighting the need for early monitoring.
Abstract:
Glucose is the most important foetal energy substrate. At birth the transplacental transfer of substrates is terminated. Before the start of breastfeeding the newborn infant must produce its own glucose particularly for the need of the central nervous system. Neonatal hypoglycaemia commonly occurs in risk groups such as immature and low birth weight infants, infants of mothers with diabetes and infants born large for gestational age. Our data show that extremely immature infants can also produce their own glucose during the first day of postnatal life. Although their stores of depot fat are limited, they also have a capacity for lipolysis. Infants of diabetic mothers have unimpaired lipolysis in spite of hyperinsulinaemia. This may represent a mechanism to compensate for the reduced rate of glucose production in these infants. The number of infants born large for gestational age is increasing in several countries partly consequent to increases in maternal weight. We have shown that foetal weight depends on maternal glucose production, which in turn is related to parameters associated with maternal fat mass. Like infants born small for gestational age, those born large for gestational age are at risk for metabolic disease later in life. Owing to a high fat mass these infants have a high rate of lipolysis, which can be one reason underlying the reduced insulin sensitivity seen already during the first day of life.
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