Neonatal hyperglycemia

Hyperglycemia — Various definitions are used for hyperglycemia in neonates

Two common definitions are blood glucose (BG) >125 mg/dL (6.9 mmol/L) or plasma glucose (the standard laboratory test) >150 mg/dL (8.3 mmol/L).

Most neonatologists define clinically important hyperglycemia as

BG >180 to 200 mg/dL (10 to 11.1 mmol/L).

causes of hyperglycemia

parenteral administration of glucose

prematurity

sepsis

Stress

Medications

Neonatal diabetes mellitus

managment of hyperglyc

Routine monitoring

initial intervention: for those in glucos iv infusion decrease it to 4 to 6 mg/kg per minute.if the BG >180 to 200 mg/dL

For neonates with persistent hyperglycemia (BG >200 mg/dL [11.1 mmol/L]) despite reducing the GIR, and for those with poor weight gain because of reduced caloric intake from low GIR, we suggest insulin therapy.

i

indications of insluin therapy

Persistent hyperglycemia (>200 mg/dL [11.1 mmol/L]) despite reduced GIR

●Poor weight gain because of low caloric intake from low GIR

dosing of insulin amd how do we monitor after that

initial bolus is given at a dose of 0.05 to 0.1 units/kg IV over 15 minutes.

•The BG level is then monitored every 30 to 60 minutes.

BG remains elevated, the bolus insulin dose can be repeated every four to six hours for up to three doses.

•If the BG remains elevated after three bolus doses of insulin, we suggest continuous infusion of insulin at an initial dose of 0.01 to 0.05 units/kg per hour IV. The infusion rate is adjusted in increments of 0.01 units/kg per hour as needed up to a maximum dose of 0.1 units/kg per hour to maintain BG levels in the target range (150 to <200 mg/dL [8.3 to 11 mmol/L]).

Target BG range — For most neonates managed with insulin therapy, we suggest a target BG range of

150 to <200 mg/dL (8.3 to <11 mmol/L).

For neonates who develop significant hypoglycemia while receiving insulin therapy, management consists of

stopping the insulin infusion and administering IV dextrose (2 mL/kg of 10% dextrose in water [D10W] given IV over 5 to 15 minutes).