16 Questions
What is a potential consequence of untreated hypoglycemia in neonates?
Neurodevelopmental impairment
What is the suggested strategy to prevent hyperglycemia in neonates receiving PN?
Avoiding excess energy delivery
What is the serum glucose concentration above which hyperglycemia is defined in VLBW infants?
150 mg/dL
What is the reported incidence of hyperglycemia in VLBW infants during the first week of life?
40-80%
What is the consequence of severe hyperglycemia in neonates?
Osmotic diuresis
What is the recommended approach to hyperglycemia prevention in neonates receiving PN?
Avoiding excess energy and dextrose delivery
What is the correlation between hyperglycemia and outcomes in neonates?
Hyperglycemia is correlated with adverse outcomes
What is the evidence level for the correlation between hyperglycemia and outcomes in neonates?
Correlational studies
What is the potential consequence of providing high glucose infusion rates to neonates receiving PN?
Hyperglycemia
Why are VLBW infants able to maintain euglycemia at a lower GIR when dextrose is administered with intravenous fat emulsion?
Because glycerol is the predominant gluconeogenic substrate
What should be considered in the event of hyperglycemia in the setting of high-dose intravenous fat emulsion provision?
Lowering the fat emulsion dose
Why should intravenous dextrose and PN formulations be tapered off over 1-2 hours in patients receiving cycled PN?
To prevent reactive hypoglycemia
What did a large RCT by Beardsall et al. find regarding early continuous insulin infusion?
It increased the incidence of hypoglycemia and mortality
What did a recent Cochrane review determine regarding early, continuous insulin infusion?
There is insufficient evidence to recommend it
What did Poindexter et al. demonstrate in a euglycemic insulin clamp model?
A 3-fold increase in plasma lactate levels
In what circumstances should insulin be used in neonates receiving PN?
Only for those patients in whom other methods of glucose control have failed
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.
Guidelines for clinical practice on glycemic control in neonates receiving parenteral nutrition, considering the risks of hyper- and hypoglycemia.
Make Your Own Quizzes and Flashcards
Convert your notes into interactive study material.
Get started for free
