Glycemic Control in Neonates Receiving Parenteral Nutrition
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Questions and Answers

What is a potential consequence of untreated hypoglycemia in neonates?

  • Osmotic diuresis
  • Dehydration
  • Electrolyte imbalance
  • Neurodevelopmental impairment (correct)

    • What is the suggested strategy to prevent hyperglycemia in neonates receiving PN?

  • Adding fat emulsion to the PN infusion
  • Increasing dextrose delivery
  • Avoiding excess energy delivery (correct)
  • Early insulin therapy

    • What is the serum glucose concentration above which hyperglycemia is defined in VLBW infants?

  • 125 mg/dL
  • 180 mg/dL
  • 150 mg/dL (correct)
  • 200 mg/dL

    • What is the reported incidence of hyperglycemia in VLBW infants during the first week of life?

    <p>40-80%</p> Signup and view all the answers

    What is the consequence of severe hyperglycemia in neonates?

    <p>Osmotic diuresis</p> Signup and view all the answers

    What is the recommended approach to hyperglycemia prevention in neonates receiving PN?

    <p>Avoiding excess energy and dextrose delivery</p> Signup and view all the answers

    What is the correlation between hyperglycemia and outcomes in neonates?

    <p>Hyperglycemia is correlated with adverse outcomes</p> Signup and view all the answers

    What is the evidence level for the correlation between hyperglycemia and outcomes in neonates?

    <p>Correlational studies</p> Signup and view all the answers

    What is the potential consequence of providing high glucose infusion rates to neonates receiving PN?

    <p>Hyperglycemia</p> Signup and view all the answers

    Why are VLBW infants able to maintain euglycemia at a lower GIR when dextrose is administered with intravenous fat emulsion?

    <p>Because glycerol is the predominant gluconeogenic substrate</p> Signup and view all the answers

    What should be considered in the event of hyperglycemia in the setting of high-dose intravenous fat emulsion provision?

    <p>Lowering the fat emulsion dose</p> Signup and view all the answers

    Why should intravenous dextrose and PN formulations be tapered off over 1-2 hours in patients receiving cycled PN?

    <p>To prevent reactive hypoglycemia</p> Signup and view all the answers

    What did a large RCT by Beardsall et al. find regarding early continuous insulin infusion?

    <p>It increased the incidence of hypoglycemia and mortality</p> Signup and view all the answers

    What did a recent Cochrane review determine regarding early, continuous insulin infusion?

    <p>There is insufficient evidence to recommend it</p> Signup and view all the answers

    What did Poindexter et al. demonstrate in a euglycemic insulin clamp model?

    <p>A 3-fold increase in plasma lactate levels</p> Signup and view all the answers

    In what circumstances should insulin be used in neonates receiving PN?

    <p>Only for those patients in whom other methods of glucose control have failed</p> Signup and view all the answers

    Study Notes

    Glycemic Control in Neonates Receiving Parenteral Nutrition

    • Neonates receiving parenteral nutrition (PN) are at a higher risk of hyper- and hypoglycemia, and may be more susceptible to adverse effects associated with these conditions.

    Risks of Hyper- and Hypoglycemia

    • Untreated hyper- or hypoglycemia can lead to undesirable clinical outcomes.
    • Prolonged or symptomatic hypoglycemia may result in neurodevelopmental impairment.
    • Severe hyperglycemia can lead to osmotic diuresis, dehydration, and electrolyte imbalance.

    Definition and Incidence of Hyperglycemia

    • Hyperglycemia is defined as a serum glucose concentration > 150 mg/dL or > 125 mg/dL in very low birth weight (VLBW) infants.
    • The incidence of hyperglycemia in VLBW infants during the first week of life ranges from 40-80%.

    Correlation between Hyperglycemia and Morbidity/Mortality

    • Persistently elevated serum glucose concentrations > 150 mg/dL are correlated with adverse clinical outcomes and/or increased mortality.
    • Research suggests a link between increased morbidity and mortality and a serum glucose level > 180 mg/dL.

    Strategies for Maintaining Optimal Blood Glucose Concentration

    • Avoid excess energy and dextrose delivery (weak recommendation).
    • Add fat emulsion to the PN infusion (weak recommendation).
    • Do not use early insulin therapy to prevent hyperglycemia (strong recommendation).
    • Evaluate the impact of treating hyper- or hypoglycemia on clinical outcomes requires further research.

    Prevention of Hypoglycemia

    • High glucose infusion rates (GIR) can lead to hyperglycemia.
    • VLBW infants can maintain euglycemia at a lower GIR when dextrose is administered with intravenous fat emulsion.
    • Lowering fat emulsion dose may be considered if hyperglycemia occurs.
    • Taper off intravenous dextrose and PN formulations over 1-2 hours to prevent reactive hypoglycemia in patients receiving cycled PN.

    Use of Early, Continuous Insulin Infusion

    • Research suggests early, continuous insulin infusion may not be beneficial in preventing hyperglycemia in neonates.
    • Concerns raised about increased incidence of hypoglycemia and mortality in the early continuous insulin infusion group.
    • Insufficient evidence to recommend early, continuous insulin infusion.
    • Insulin should be used only for patients in whom other methods of glucose control have failed.

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    Description

    Guidelines for clinical practice on glycemic control in neonates receiving parenteral nutrition, considering the risks of hyper- and hypoglycemia.

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