Background: Appropriate management for hyperglycemia is essential in preterm infants, because hyperglycemia increase the risk for intracranial hemorrhage, sepsis, retinopathy of prematurity, impairing long outcome to mortality and morbidity. In general, transient neonatal hyperglycemia is frequently observed during glucose infusion therapy, and it may not require interventions other than reducing glucose infusion. On the other hand, extremely preterm infants (EPIs GA <28 weeks) have been reported to occasionally develop transient hyperglycemia in the absence of glucose infusion. The glucose infusion independent hyperglycemia occurs after nutritional transition from parenteral to enteral feeding is completed. Such transient late-onset hyperglycemia should be clinically differentiated from general neonate hyperglycemia, because it tends to be prolonged and requires appropriate intervention, such as insulin therapy. Despite of its clinical significance, clinical details of the transient late-onset hyperglycemia are not elucidated.
Aim: Identifying risks for transient late-onset hyperglycemia in EPIs.
Subjects and methods: We retrospectively analysed 25 EPIs who were born in a single medical institute from April 2015 to March 2018. The patients with severe complications, such as requiring cardiac or gastrointestinal surgery, or lethal cases were excluded. Hyperglycemia was defined as more than 180 mg/dl (10 mmol/l) of blood glucose levels were documented in two or more sequential measurements.
Results: Among 25 subjects, eight infants (32%) developed transient late-onset hyperglycemia. The prevalence of the late-onset hyperglycemia was significantly higher in the infants who were born 23 or less weeks of gestation (6/8 in =<23 weeks vs 2/17 in >=24 weeks, P=0.01), and the odds ratio was 24.0. The mean duration of hyperglycemia was 37.0 days (25th percentiles: 19.3 days, 75th percentiles: 52.5 days). The median of postmenstrual age at disappearance of hyperglycemia was 30.1 weeks (25th percentiles: 29.5 weeks, 75th percentiles: 32.4 weeks). Early (≤5 days after birth) minimal enteral nutrition was performed for seven out of eight infants with late onset hyperglycemia, and 5 out of 8 infants received insulin therapy.
Discussion: Our data suggested that EPIs born at 23 or less weeks gestational age is a risk for transient late-onset hyperglycemia. Further, the hyperglycemia was prolonged more than 30 days that would seriously affect growth and development of the infants. Early minimal enteral nutrition for premature infants has been considered to be favorable for preventing hyperglycemia, but, according our data, for preventing transient late-onset hyperglycemia, the treatment was not efficient and different nutritional approach could be considered for EPIs born at 23 or less weeks.
27 - 29 Sep 2018
European Society for Paediatric Endocrinology