Hyperglycaemia in the Newborn Infant. Physiology Verses Pathology
1Department of Paediatrics, University of Cambridge, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, United Kingdom.
Insights
Hyperglycemia in critically ill newborns, especially preterm infants, is linked to poor outcomes. Continuous glucose monitoring (CGM) aids management and reduces hypoglycemia risk in preterm infants.
Area of Science:
- Neonatalogy
- Pediatric Intensive Care
- Endocrinology
Background:
- Hyperglycemia is prevalent in critically ill newborns, particularly preterm infants, those with sepsis, or perinatal hypoxia.
- Elevated blood glucose levels in neonates are associated with increased mortality and morbidity.
- Optimal management targets and intervention strategies for neonatal hyperglycemia remain debated due to limited evidence.
Purpose of the Study:
- To review the clinical significance of hyperglycemia in neonatal intensive care.
- To discuss current controversies and evidence regarding intervention thresholds and management strategies.
- To explore the role of continuous glucose monitoring (CGM) in neonatal glucose management.
Main Methods:
- Literature review of studies on neonatal hyperglycemia.
- Analysis of clinical significance, mortality, and morbidity data.
- Evaluation of management strategies including glucose infusion rate (GIR) and insulin use.
Main Results:
- Hyperglycemia is a common and serious complication in neonatal intensive care units (NICUs).
- Continuous glucose monitoring (CGM) has shown promise in improving glucose control and reducing hypoglycemia in preterm infants.
- Insulin use, while helpful, carries a risk of hypoglycemia, especially in extremely preterm infants.
Conclusions:
- Identifying and treating underlying causes of hyperglycemia is paramount.
- CGM offers a valuable tool for optimizing glucose control and minimizing hypoglycemia risks in preterm neonates.
- Further research is needed to establish optimal glucose targets and explore advanced management systems like closed-loop control.
Abstract:
Hyperglycemia is common in newborns requiring intensive care, particularly in preterm infants, in sepsis and following perinatal hypoxia. The clinical significance, and optimal intervention strategy varies with context, but hyperglycaemia is associated with increased mortality and morbidity. The limited evidence for optimal clinical targets mean controversy remains regarding thresholds for intervention, and management strategies. The first consideration in the management of hyperglycaemia must be to ascertain potentially treatable causes. Calculation of the glucose infusion rate (GIR) to insure this is not excessive, is critical but the use of insulin is often helpful in the extremely preterm infant, but is associated with an increased risk of hypoglycaemia. The use of continuous glucose monitoring (CGM) has recently been demonstrated to be helpful in targeting glucose control, and reducing the risk from hypoglycaemia in the preterm infant. Its use in other at risk infants remains to be explored, and further studies are needed to provide a better understanding of the optimal glucose targets for different clinical conditions. In the future the combination of CGM and advances in computer algorithms, to provide intelligent closed loop systems, could allow a safer and more personalized approached to management.
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