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Ernesto Valdes MD, Guest Editor
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NEONATAL GLUCOSE ISSUES
Speaker Peter M. Henry, M.D., PhD, Baylor College of Medicine
They defined normal blood glucose values for the VLBW infant between 40-100 mg/dL. Despite most recent definition of infant hypoglycemia to be below 50 mg/dL; acquired from the fetal plasma glucose level of 50 mg/dL
Up to 250 mg/dL was not associated with specific morbidity. High values do increase serum osmolality (180 mg = 10 mOsm), but only rarely cause osmotic diuresis or dehydration.
We find hyperglycemia in 80% of VLBW infants receiving 10 gm/kg/day of glucose. He remarked that restriction of glucose intake below this rate to avoid hyperglycemia is nutritionally unsound. The approach of exogenous insulin lowering blood glucose reverses catabolic effects and promotes improved growth in these infants.
He recommended insulin administration for persistent blood glucose values greater than 250 mg/dL. The starting dose is 0.05 U/gm of carbohydrate. Titrate insulin according to the responses of blood glucose and subsequent increases in carbohydrate intake. Run the drip @ 0.2 ml/hr in D5W and 0.25 U bolus for glucose over 400 mg/dL or hyperkalemia.
Goals of insulin administration are to attain appropriate weight gain on full intake of TPN and IV lipids. Also to maintain of a majority of blood glucose values below 250 mg/dL. Rigid control of hyperglycemia is unnecessary. The occurrence of hypoglycemia while infusing insulin is approximately 1%.
Comments. We have had experience with insulin use and how
difficult it is to titrate. But we have seen these infants gain weight more
quickly on insulin, and achieve extubation and possible discharge sooner. EV.
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