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.
Frontiers in Pediatrics
|August 9, 2021
Summary
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.
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