18 Questions
What is the primary focus of this Clinical Guideline?
Glycemic control in neonates receiving parenteral nutrition within the first month of life
What is a potential consequence of untreated hyper- or hypoglycemia in neonates?
Dehydration and electrolyte imbalance
What is the name of the organization that developed these guidelines?
American Society for Parenteral and Enteral Nutrition
How often does the A.S.P.E.N. Board of Directors evaluate individual guidelines for updates?
No specific frequency is mentioned
Why are point of care reagent test strips not recommended for determining blood glucose concentration in neonates?
They are susceptible to errors due to contamination with alcohol and elevated hematocrit
What is the sensitivity of reagent test strips for detecting hypoglycemia in neonates?
82-83%
What is the recommended method for determining blood glucose concentration in neonates?
Laboratory serum glucose or glucose electrode measurements
What is the primary goal of the A.S.P.E.N. Clinical Guidelines?
To improve patient care by advancing the science and practice of clinical nutrition and metabolism
What is the recommended serum glucose concentration to minimize clinical complications in neonates receiving PN?
< 150 mg/dL
What is the strongest indicator of early death or intraventricular haemorrhage (IVH) in ELBW infants?
Hyperglycemia
What is the leading cause of death in premature VLBW infants?
Sepsis
What is the correlation coefficient between the maximum serum glucose levels and the duration of parenteral nutrition?
r = 0.45, P = 0.005
What is the prevalence of hyperglycemia in infants born at or after 26 weeks of gestational age?
Less than 50%
What is the mortality rate for individuals with severe hyperglycemia in premature VLBW infants?
22.2%
What is the correlation between hyperglycemia and the risk of retinopathy of prematurity (ROP)?
Positive correlation
What is the sensitivity of hyperglycemia as an indicator of early death or intraventricular haemorrhage (IVH)?
91%
What is the prevalence of hyperglycemia in the study by Kao?
65%
What is the mortality rate in individuals with high levels of stress in the study by Lilien?
83.3%
Study Notes
Neonatal Glycemic Control and Parenteral Nutrition
- Neonates receiving parenteral nutrition (PN) are at a higher risk of hyper- and hypoglycemia, leading to negative outcomes.
- Untreated hyper- or hypoglycemia can result in neurodevelopmental impairment, dehydration, and electrolyte imbalance, and increased morbidity and mortality in premature infants.
A.S.P.E.N. Clinical Guidelines
- The American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) aims to improve patient care by advancing the science and practice of clinical nutrition and metabolism.
- A.S.P.E.N. has been publishing Clinical Guidelines since 1986 and evaluates when individual guidelines should be updated.
Determining Blood Glucose Concentration in Neonates
- Blood glucose concentration in neonates should be determined using laboratory serum glucose or glucose electrode measurements, rather than point of care reagent test strips.
- Point of care reagent test strips may be susceptible to errors due to contamination with alcohol, elevated hematocrit, and a 15% lower glucose concentration compared to laboratory plasma glucose values.
Blood Glucose Concentration and Clinical Complications in Neonates
- Moderate and severe hyperglycemia in premature very low birth weight (VLBW) infants are associated with increased mortality rates.
- Mortality rates for different levels of blood glucose are as follows: normoglycemia (13.4%), moderate hyperglycemia (7.2%), and severe hyperglycemia (22.2%).
- Maximum serum glucose levels are positively correlated with the duration of parenteral nutrition, the number of days on the ventilator, and the length of stay in the hospital.
- Keeping the serum glucose concentration < 150 mg/dL is recommended to reduce clinical complications.
Hyperglycemia and Neonatal Outcomes
- Hyperglycemia is associated with increased risk of retinopathy of prematurity (ROP), intraventricular haemorrhage (IVH), and mortality in extremely low birth weight (ELBW) infants.
- Hyperglycemia is a strong indicator of early death or IVH in ELBW infants, with a sensitivity of 91% and specificity of 25%.
- Mild to moderate hyperglycemia is not significantly linked to death or infection, after adjusting for age.
- Stress is linked to higher mortality rates and IVH, although it is not significantly associated with hyperglycemia.
This quiz focuses on the management of blood sugar levels in newborns receiving parenteral nutrition within the first month of life. It covers the risks and consequences of hyper- and hypoglycemia in neonates.
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