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Balasundaram P, Lucena MH, Nafday S. A Neonate with a Rare Presentation of Persistent Hypoglycemia and Prolonged Jaundice. Neoreviews 2023; 24:39-42. [PMID: 36587006 DOI: 10.1542/neo.24-1-e39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
| | - Michelle H Lucena
- Division of Neonatology, Albert Einstein Montefiore Medical Center, Bronx, NY
| | - Suhas Nafday
- Division of Neonatology, Albert Einstein Montefiore Medical Center, Bronx, NY
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2
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Abraham M. Practical management and treatment of foals with neonatal encephalopathy/neonatal maladjustment syndrome in an ICU setting. EQUINE VET EDUC 2022. [DOI: 10.1111/eve.13642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- M. Abraham
- Department of Clinical Sciences New Bolton Center The University of Pennsylvania School of Veterinary Medicine Kennett Square Pennsylvania USA
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3
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Janjindamai W, Tiwawatpakorn N, Thatrimontrichai A, Dissaneevate S, Maneenil G, Phatigomet M. Accuracy of neonatal venous blood glucose measurements using blood gas analyzer compared with central laboratory chemistry analyzer. J Clin Neonatol 2022. [DOI: 10.4103/jcn.jcn_110_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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4
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Edwards T, Harding JE. Clinical Aspects of Neonatal Hypoglycemia: A Mini Review. Front Pediatr 2021; 8:562251. [PMID: 33489995 PMCID: PMC7820332 DOI: 10.3389/fped.2020.562251] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 12/10/2020] [Indexed: 12/24/2022] Open
Abstract
Introduction: Neonatal hypoglycemia is common and a preventable cause of brain damage. The goal of management is to prevent or minimize brain injury. The purpose of this mini review is to summarize recent advances and current thinking around clinical aspects of transient neonatal hypoglycemia. Results: The groups of babies at highest risk of hypoglycemia are well defined. However, the optimal frequency and duration of screening for hypoglycemia, as well as the threshold at which treatment would prevent brain injury, remains uncertain. Continuous interstitial glucose monitoring in a research setting provides useful information about glycemic control, including the duration, frequency, and severity of hypoglycemia. However, it remains unknown whether continuous monitoring is associated with clinical benefits or harms. Oral dextrose gel is increasingly being recommended as a first-line treatment for neonatal hypoglycemia. There is some evidence that even transient and clinically undetected episodes of neonatal hypoglycemia are associated with adverse sequelae, suggesting that prophylaxis should also be considered. Mild transient hypoglycemia is not associated with neurodevelopmental impairment at preschool ages, but is associated with low visual motor and executive function, and with neurodevelopmental impairment and poor literacy and mathematics achievement in later childhood. Conclusion: Our current management of neonatal hypoglycemia lacks a reliable evidence base. Randomized trials are required to assess the effects of different prophylactic and treatment strategies, but need to be adequately powered to assess outcomes at least to school age.
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Affiliation(s)
| | - Jane E. Harding
- Liggins Institute, University of Auckland, Auckland, New Zealand
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5
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Bischoff AR, Grass B, Fan CPS, Tomlinson C, Lee KS. Risk factors for postoperative hyperglycemia in neonates. J Neonatal Perinatal Med 2020; 14:183-191. [PMID: 32925115 DOI: 10.3233/npm-200535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Postoperative hyperglycemia has been shown to be associated with higher morbidity and mortality in pediatric patients. Data on risk factors for neonatal patients is limited. The objective of this study was to identify pre- and intraoperative risk factors associated with postoperative glucose in neonates. METHODS We conducted a retrospective cohort study of neonates after surgical procedures between January and December 2016 in a quaternary neonatal intensive care unit. The primary outcome was hyperglycemia defined as serum glucose ≥8.3 mmol/L during the first 4 hours postoperatively. Secondary outcomes included death and length of stay. We assessed the association of risk factors with the postoperative glucose. RESULTS In total, 206 surgical procedures (171 patients) were evaluated, among which 178 had serum glucose values during the first 4 hours postoperatively available. The incidence of hyperglycemia was 54% (n = 96). The median (IQR) glucose during the first 4 hours in NICU was 8.4 (6.52-10.65) mmol/L. Risk factors for postoperative hyperglycemia were intraoperative glucose infusion rate (GIR) and gestational age. There was a non-linear relationship between gestational age and postoperative hyperglycemia. Mortality occurred in 6 (7%) in the no-hyperglycemia group and 3 (3%) in the hyperglycemia group (p = 0.31). CONCLUSIONS Among the risk factors, intraoperative GIR was identified as a modifiable factor that can reduce postoperative hyperglycemia. A non-linear relationship of gestational age with postoperative glucose provides new insights that may help advance our understanding of the complex mechanisms of glucose homeostasis in neonates.
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Affiliation(s)
- Adrianne R Bischoff
- Division of Neonatology, The Hospital for Sick Children, Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Beate Grass
- Division of Neonatology, The Hospital for Sick Children, Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Chun-Po Steve Fan
- Cardiovascular Data Management Centre, The Hospital for Sick Children, University of Toronto, Ontario, Canada
| | - Christopher Tomlinson
- Division of Neonatology, The Hospital for Sick Children, Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Kyong-Soon Lee
- Division of Neonatology, The Hospital for Sick Children, Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
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Adeniji EO, Kuti BP, Elusiyan JB. Relationship between serum insulin and point-of-admission blood glucose of ill neonates at a tertiary health facility in Nigeria. Pan Afr Med J 2020; 35:106. [PMID: 32637004 PMCID: PMC7320779 DOI: 10.11604/pamj.2020.35.106.18929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 02/16/2020] [Indexed: 11/12/2022] Open
Abstract
Introduction Optimal glucose metabolism is important in neonatal survival especially in the first days of life. Insulin play a significant role in maintaining blood glucose homeostasis. This study set out to determine the serum insulin levels of ill neonates as related to their point-of-admission blood glucose estimation at the Wesley Guild Hospital, Ilesa, Nigeria. Methods Three hundred babies took part in the study. Blood glucose and serum insulin levels were assayed at admission using Accu-Chek Active glucometer(R) and Accu-Ɔ-Bind ELISA Microwells(R) respectively. Hyperglycaemia was defined as blood glucose ≥7mmol/L and hypoglycaemia as blood glucose <2.2mmol/L. Results The median (IQR) age of the babies was 10.0 (0.5 - 70.0) hours with male to female ratio of 1.5:1. Seventy-four (24.7%) were preterms and 35 (11.7%) were small-for-gestational age. The mean (SD) blood glucose level of the babies was 4.1(2.1) mmol/L with a range of 0.6-13.4mmol/L. Hyperglycaemia and hypoglycaemia were observed in 18(6.0%) and 40(13.3%) babies respectively. The median (IQR) serum insulin level was 9.8(3.0-35.3) μIU/ml. There was weak positive correlation between serum insulin and blood glucose levels of the babies (r = 0.197, p = 0.001). Birth asphyxia was associated with lower serum insulin, while probable sepsis with relatively higher levels. Conclusion Serum insulin level increases with increasing blood glucose in ill Nigerian babies at presentation to the hospital. Babies with asphyxia and sepsis particularly tend to have abnormal serum insulin at admission. Hyperinsulinaemia in ill babies may connote a compensatory mechanism to normalise abnormal blood glucose rather than playing significant role in its aetio-pathogenesis.
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Affiliation(s)
- Emmanuel Oluwatosin Adeniji
- Department of Paediatrics and Child Health, College of Health Sciences, Ladoke Akintola University of Technology, Osogbo, Nigeria
| | - Bankole Peter Kuti
- Department of Paediatrics and Child Health, Obafemi Awolowo University, Ile-Ife, Nigeria
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Tuzun F, Akcura Y, Duman N, Ozkan H. Comparison of isotonic and hypotonic intravenous fluids in term newborns: is it time to quit hypotonic fluids. J Matern Fetal Neonatal Med 2020; 35:356-361. [PMID: 32223482 DOI: 10.1080/14767058.2020.1718094] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: Hypotonic fluids have been traditionally used in newborns. National Institute for Health and Clinical Excellence-2015 (NICE) fluid therapy guideline recommends the use of isotonic fluids as maintenance fluid therapy in term newborns. However, there is no clear evidence supporting this recommendation. This study aims to compare isotonic (5% dextrose in 0.9% sodium chloride (NaCl)) and hypotonic (5% dextrose in 0.45% NaCl) parenteral fluid therapies in hospitalized term newborns with regard to changes in plasma Na (pNa) and complications related with fluid therapy.Methods: This was a retrospective cohort study performed in a tertiary university hospital NICU between January 2016 and April 2018. Term newborns who were initially isonatremic or mildly dysnatremic (pNa <130 or >155 meq/L) and receiving fluid therapy for maintenance or replacement therapy after 48th postnatal hours were eligible for the study. Infants having specific diagnoses requiring extraordinary fluids were excluded. The primary outcome evaluated was the change in mean plasma Na (ΔpNa meq/L/h) at 24 h or at the end of intravenous (i.v.) fluid therapy. Secondary outcomes evaluated were the risk of hyponatremia, hypernatremia, and adverse events attributable to fluid administration.Results: Among the 108 included newborns, 57 received hypotonic fluid (5% dextrose solution in 0.45% NaCl) and the remaining received isotonic fluid (5% dextrose solution in 0.9% NaCl) therapy. The hypotonic fluid group showed a greater ΔpNa compared to the isotonic group (0.48 ± 0.28 vs. 0.27 ± 0.21 meq/L/h, p = .001). The risk of experiencing unsafe plasma Na decrease in the hypotonic fluid group (ΔpNa >0.5 meq/L/h) was higher than the isotonic fluid group (odd ratio: 8.46; 95% confidence interval (CI): 2.3-30.06). Six mildly hypernatremic babies between 48 and 72 h of postnatal age showed insufficient Na reduction despite the appropriate amount of fluid. No significant difference was found between the two groups in terms of other outcomes.Conclusion: The results of this study suggested that as maintenance or replacement fluid therapy in the newborn, hypotonic fluids, even 5% dextrose in 0.45% NaCl, can lead to unsafe plasma Na decreases in term newborns, while isotonic fluids are safe when started after the first few days of life. Although the results parallel NICE guidelines, before making recommendations regarding the removal of hypotonic fluids entirely from clinical practice in term newborns following the renal adaptation period; larger randomized controlled studies involving a wide range of babies are needed.
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Affiliation(s)
- Funda Tuzun
- Department of Pediatrics, Division of Neonatology, Dokuz Eylül University Faculty of Medicine, Izmir, Turkey
| | - Yagmur Akcura
- Department of Pediatrics, Division of Neonatology, Dokuz Eylül University Faculty of Medicine, Izmir, Turkey
| | - Nuray Duman
- Department of Pediatrics, Division of Neonatology, Dokuz Eylül University Faculty of Medicine, Izmir, Turkey
| | - Hasan Ozkan
- Department of Pediatrics, Division of Neonatology, Dokuz Eylül University Faculty of Medicine, Izmir, Turkey
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El-Kadi SW, McCauley SR, Seymour KA, Sunny NE, Rhoads RP. Lipid Intake Enhances Muscle Growth But Does Not Influence Glucose Kinetics in 3-Week-Old Low-Birth-Weight Neonatal Pigs. J Nutr 2019; 149:933-941. [PMID: 31149711 DOI: 10.1093/jn/nxz030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 11/09/2018] [Accepted: 02/06/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Low-birth-weight (LBWT) neonates grow at a slower rate than their normal-birth-weight (NBWT) counterparts and may develop hypoglycemia postnatally. OBJECTIVE We investigated whether dietary lipid supplementation would enhance growth and improve glucose production in LBWT neonatal pigs. METHODS Twelve 3-d-old NBWT (1.606 kg) crossbred pigs were matched to 12 LBWT (1.260 kg) same-sex littermates. At 6 d of age, 6 pigs in each group were fed a low-energy (LE) or a high-energy (HE) isonitrogenous formula containing 5.2% and 7.3% fat, respectively. Body composition was assessed using dual-energy X-ray absorptiometry; plasma glucose and glycerol kinetics were assessed using stable isotope tracers. After killing, weights of skeletal muscles and visceral organs were measured. Data were analyzed by ANOVA for a 2 × 2 factorial design; temporal effects were investigated using repeated-measures analysis. RESULTS Lipid supplementation did not affect body weight of LBWT or NBWT pigs. However, liver and longissimus dorsi weights as a percentage of body weight were greater for pigs fed an HE diet than for those fed an LE diet (4.3% compared with 3.4% and 1.5% compared with 1.2%, respectively) but remained less for LBWT than for NBWT pigs (3.8% compared with 3.9% and 1.3% compared with 1.5%, respectively) (P < 0.05). In addition, hepatic fat content increased (7.9 compared with 2.6 g) in pigs fed the HE compared with those fed the LE formula (P < 0.05). Lipid supplementation did not influence plasma glucose concentration which remained lower in the LBWT than in the NBWT group (4.1 compared with 4.5 mmol/L) (P < 0.05). CONCLUSIONS Our data suggest that lipid supplementation modestly improved growth of skeletal muscle and the liver but did not affect glucose homeostasis in all groups, and glucose concentration remained lower in LBWT than in NBWT pigs. These data suggest that the previously reported hyperglycemic effect of lipid supplementation may depend on the route of administration or age of the neonatal pig.
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Affiliation(s)
- Samer W El-Kadi
- Department of Animal and Poultry Sciences, Virginia Tech, Blacksburg, VA
| | - Sydney R McCauley
- Department of Animal and Poultry Sciences, Virginia Tech, Blacksburg, VA
| | - Kacie A Seymour
- Department of Animal and Poultry Sciences, Virginia Tech, Blacksburg, VA
| | - Nishanth E Sunny
- Department of Animal and Avian Sciences, University of Maryland, College Park, MD
| | - Robert P Rhoads
- Department of Animal and Poultry Sciences, Virginia Tech, Blacksburg, VA
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Hwang MJ, Newman R, Philla K, Flanigan E. Use of Insulin Glargine in the Management of Neonatal Hyperglycemia in an ELBW Infant. Pediatrics 2018; 141:S399-S403. [PMID: 29610159 DOI: 10.1542/peds.2016-1638] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/05/2017] [Indexed: 11/24/2022] Open
Abstract
Neonatal hyperglycemia is common in extremely low birth weight (ELBW) infants because of physiologic stress, exogenous glucose infusion, and postnatal corticosteroid therapy for hypotension, adrenal insufficiency, and pulmonary immaturity. The use of long-acting insulin glargine has been described in the treatment of transient neonatal diabetes in the premature infant, but in these reports is a lack of regard to its use in the treatment of iatrogenic neonatal hyperglycemia. We present the case of an ELBW infant with significant hyperglycemia that was refractory to usual treatment but demonstrated a favorable response to long-acting subcutaneous insulin glargine. The pharmacokinetics on regular insulin and long-acting insulin are different. Regular insulin is broken down into biologically active monomers after subcutaneous injection, and long-acting insulin forms microprecipitates and is gradually released to the body at a neutral physiologic pH after subcutaneous injection. Pharmacokinetics of both regular insulin and long-acting insulin are not clear in ELBW infants. However, with further research on long-acting insulin, it can be used safely to achieve consistent euglycemia with once-daily administration in neonatal hyperglycemia.
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Affiliation(s)
- Min J Hwang
- Department of Pediatrics, Madigan Army Medical Center, Tacoma, Washington
| | - Robert Newman
- Department of Pediatrics, Madigan Army Medical Center, Tacoma, Washington
| | - Katherine Philla
- Department of Pediatrics, Madigan Army Medical Center, Tacoma, Washington
| | - Elizabeth Flanigan
- Department of Pediatrics, Madigan Army Medical Center, Tacoma, Washington
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Mola-Schenzle E, Staffler A, Klemme M, Pellegrini F, Molinaro G, Parhofer KG, Messner H, Schulze A, Flemmer AW. Clinically stable very low birthweight infants are at risk for recurrent tissue glucose fluctuations even after fully established enteral nutrition. Arch Dis Child Fetal Neonatal Ed 2015; 100:F126-31. [PMID: 25381093 DOI: 10.1136/archdischild-2014-306168] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE In previous cases, we have observed occasional hypoglycaemic episodes in preterm infants after initial intensive care. In this prospective study, we determined the frequency and severity of abnormal tissue glucose (TG) in clinically stable preterm infants on full enteral nutrition. METHODS Preterm infants born at <1000 g (n=23; G1) and birth weight 1000-1500 g (n=18; G2) were studied at a postmenstrual age of 32±2 weeks (G1) and 33±2 weeks (G2). Infants were fed two or three hourly, according to a standard bolus-nutrition protocol, and continuous subcutaneous glucose measurements were performed for 72 h. Normal glucose values were assumed at ≥2.5 mmol/L (45 mg/dL) and ≤8.3 mmol/L (150 mg/dL). Frequency, severity and duration of glucose values beyond normal values were determined. RESULTS We observed asymptomatic low TG values in 39% of infants in G1 and in 44% in G2. High TG values were detected in 83% in G1 and 61% in G2. Infants in G1 experienced prolonged and more severe low TG episodes, and also more frequent and severe high TG episodes. In G1 and G2, 87% and 67% of the infants, respectively, showed glucose fluctuations characterised by rapid glucose increase followed by a rapid glucose drop after feeds. In more mature infants, glucose fluctuations were less pronounced and less dependent on enteral feeds. CONCLUSIONS Clinically stable well-developing preterm infants beyond their initial period of intensive care show interstitial glucose instabilities exceeding values as low as 2.5 mmol/L and as high as 8.3 mmol/L. This novel observation may play an important role for the susceptibility of these high-risk infants for the development of the metabolic syndrome. TRIAL REGISTRATION NUMBER German trial registration number DRKS00004590.
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Affiliation(s)
- E Mola-Schenzle
- Division of Neonatology, Dr von Hauner Children's Hospital and Perinatal Center, Ludwig Maximilian University Munich-Grosshadern, Munich, Germany
| | - A Staffler
- Division of Neonatology, Regional Hospital Bolzano, Bolzano, Italy
| | - M Klemme
- Division of Neonatology, Dr von Hauner Children's Hospital and Perinatal Center, Ludwig Maximilian University Munich-Grosshadern, Munich, Germany
| | - F Pellegrini
- Division of Neonatology, Regional Hospital Bolzano, Bolzano, Italy
| | - G Molinaro
- Division of Neonatology, Regional Hospital Bolzano, Bolzano, Italy
| | - K G Parhofer
- Department of Internal Medicine, Ludwig-Maximilian-University Munich-Grosshadern, Munich, Germany
| | - H Messner
- Division of Neonatology, Regional Hospital Bolzano, Bolzano, Italy
| | - A Schulze
- Division of Neonatology, Dr von Hauner Children's Hospital and Perinatal Center, Ludwig Maximilian University Munich-Grosshadern, Munich, Germany
| | - A W Flemmer
- Division of Neonatology, Dr von Hauner Children's Hospital and Perinatal Center, Ludwig Maximilian University Munich-Grosshadern, Munich, Germany
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Wight N, Marinelli KA. ABM clinical protocol #1: guidelines for blood glucose monitoring and treatment of hypoglycemia in term and late-preterm neonates, revised 2014. Breastfeed Med 2014; 9:173-9. [PMID: 24823918 PMCID: PMC4026103 DOI: 10.1089/bfm.2014.9986] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A central goal of The Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.
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Affiliation(s)
- Nancy Wight
- 1 San Diego Neonatology, Inc. , San Diego, California
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Abstract
OBJECTIVES To determine the incidence and study association of hyperglycemia with outcome of critically ill children. SETTING AND DESIGN This was a prospective observational study conducted in eight bedded pediatric intensive care unit (PICU) of a tertiary care hospital. MATERIALS AND METHODS One hundred and one critically ill non-diabetic children between ages of 1 month to 16 years were studied from the day of admission till discharge or death. Serial blood sugars were determined first at admission, thereafter every 12 hourly in all children. Blood glucose level above 126 mg/dl (>7 mmol/dl) was considered as hyperglycemia. Children with hyperglycemia were followed 6 hourly till blood glucose fell below 126 mg/dl. Hyper and non-hyperglycemic children were compared with respect to length of stay, mechanical ventilation, use of inotrops and final outcome. Survivors and non-survivors were compared in relation to admission blood glucose, peak blood glucose level and duration of hyperglycemia. RESULTS Seventy (69.3%) children had hyperglycemia. Requirement of ventilation [(23) 32.9% vs.(3) 9.7%], requirement of inotropic support [(27) 38.6% vs.(5) 16.1%], Mean length of stay in PICU (7.91 ± 5.01 vs. 5.58 ± 1.95 days) and mortality (28.6% vs. 3.2%) among hyperglycemic children was significantly higher (P < 0.05) than that of non-hyperglycemic. Logistic regression analysis showed Peak blood glucose level and duration of hyperglycemia has independent association with increased risk of death. CONCLUSION Incidence of hyperglycemia is high in critically ill children and it is associated with high morbidity and mortality.
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Affiliation(s)
| | - Swati Balasaheb Chougule
- Department of Pediatrics, Bharati Vidyapeeth University Medical College, Sangli, Maharashtra, India
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Auerbach A, Eventov-Friedman S, Arad I, Peleg O, Bdolah-Abram T, Bar-Oz B, Zangen DH. Long duration of hyperglycemia in the first 96 hours of life is associated with severe intraventricular hemorrhage in preterm infants. J Pediatr 2013; 163:388-93. [PMID: 23472766 DOI: 10.1016/j.jpeds.2013.01.051] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Revised: 12/20/2012] [Accepted: 01/23/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the association between severe intraventricular hemorrhage (IVH) and blood glucose variables during the first 96 hours of life in preterm infants. STUDY DESIGN Preterm infants with IVH grade 3-4 (n = 70) were compared with matched infants of similar gestational age and birth weight, but with no IVH (n = 108). Studied variables included the frequency and duration of hyper/hypoglycemic (>6.9/<3.3 mmol/L, respectively) events, the extreme slope of an event evolution, the maximal glucose value observed, and the "hyper/hypoglycemic index" representing a weighted average of the hyper/hypoglycemic amplitude. RESULTS The IVH group had significantly more hyperglycemic events (2.9 ± 1.7 vs 2.4 ± 1.8 events, P < .05) with longer duration (22.2 ± 14.2 vs 14.1 ± 12.5 hours, P < .001) and a higher hyperglycemic index (1.0 ± 0.9 vs 1.4 ± 1.0, P = .003) compared with the non-IVH controls. Respiratory distress syndrome, hypotension, and thrombocytopenia increased the adjusted OR for IVH. Hypoglycemia was not independently associated with IVH. Conversely, the increase in hyperglycemic duration was most prominently increasing the aOR for severe IVH (OR = 10.33, 95% CI = 10.0-10.6, P = .033). CONCLUSION Longer duration of hyperglycemia in the first 96 hours of life was most strongly associated with severe IVH in preterm infants. Consequently, interventional studies to determine the selective effect of continuous control of long-lasting hyperglycemia by appropriate and timed insulin treatment on the incidence of severe IVH are warranted.
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Affiliation(s)
- Adi Auerbach
- Division of Pediatric Endocrinology, Department of Pediatrics, Hadassah Hebrew University Medical Center, Jerusalem, Israel
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14
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Stoll B, Puiman PJ, Cui L, Chang X, Benight NM, Bauchart-Thevret C, Hartmann B, Holst JJ, Burrin DG. Continuous parenteral and enteral nutrition induces metabolic dysfunction in neonatal pigs. JPEN J Parenter Enteral Nutr 2012; 36:538-50. [PMID: 22549765 DOI: 10.1177/0148607112444756] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND We previously showed that parenteral nutrition (PN) compared with formula feeding results in hepatic insulin resistance and steatosis in neonatal pigs. The current aim was to test whether the route of feeding (intravenous [IV] vs enteral) rather than other feeding modalities (diet, pattern) had contributed to the outcome. METHODS Neonatal pigs were fed enterally or parenterally for 14 days with 1 of 4 feeding modalities as follows: (1) enteral polymeric formula intermittently (FORM), (2) enteral elemental diet (ED) intermittently (IEN), (3) enteral ED continuously (CEN), and (4) parenteral ED continuously (PN). Subgroups of pigs underwent IV glucose tolerance tests (IVGTT) and hyperinsulinemic-euglycemic clamps (CLAMP). Following CLAMP, pigs were euthanized and tissues collected for further analysis. RESULTS Insulin secretion during IVGTT was significantly higher and glucose infusion rates during CLAMP were lower in CEN and PN than in FORM and IEN. Endogenous glucose production rate was suppressed to zero in all groups during CLAMP. In the fed state, plasma glucose-dependent insulinotropic polypeptide (GIP), glucagon-like peptide (GLP)-1, and GLP-2 were different between feeding modalities. Insulin receptor phosphorylation in liver and muscle was decreased in IEN, CEN, and PN compared with FORM. Liver weight was highest in PN. Steatosis and myeloperoxidase (MPO) activity tended to be highest in PN and CEN. Enterally fed groups had higher plasma GLP-2 and jejunum weight compared with PN. CONCLUSIONS PN and enteral nutrition (EN) when given continuously as an elemental diet reduces insulin sensitivity and the secretion of key gut incretins. The intermittent vs continuous pattern of EN produced the optimal effect on metabolic function.
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Affiliation(s)
- Barbara Stoll
- USDA/ARS Children's Nutrition Research Center, Houston, Texas 77030, USA.
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Hyman SJ, Novoa Y, Holzman I. Perinatal endocrinology: common endocrine disorders in the sick and premature newborn. Pediatr Clin North Am 2011; 58:1083-98, ix. [PMID: 21981950 DOI: 10.1016/j.pcl.2011.07.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Endocrine disorders are common in infants in the neonatal ICU. They often are associated with prematurity, low birth weight or very low birth weight, and small size for gestational age. They also frequently occur in infants who are critically ill or stressed. This article describes the most common conditions and current knowledge regarding management.
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Affiliation(s)
- Sharon J Hyman
- Division of Pediatric Endocrinology and Diabetes, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1616, New York, NY 10029, USA.
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Phalen AG, Schwoebel A. Glucose Homeostasis in the Neonate: Protection Against Cerebral Injury. ACTA ACUST UNITED AC 2011. [DOI: 10.1053/j.nainr.2011.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Stoll B, Horst DA, Cui L, Chang X, Ellis KJ, Hadsell DL, Suryawan A, Kurundkar A, Maheshwari A, Davis TA, Burrin DG. Chronic parenteral nutrition induces hepatic inflammation, steatosis, and insulin resistance in neonatal pigs. J Nutr 2010; 140:2193-200. [PMID: 20980637 PMCID: PMC2981005 DOI: 10.3945/jn.110.125799] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Prematurity and overfeeding in infants are associated with insulin resistance in childhood and may increase the risk of adult disease. Total parenteral nutrition (TPN) is a major source of infant nutritional support and may influence neonatal metabolic function. Our aim was to test the hypothesis that TPN induces increased adiposity and insulin resistance compared with enteral nutrition (EN) in neonatal pigs. Neonatal pigs were either fed enteral formula orally or i.v. administered a TPN mixture for 17 d; macronutrient intake was similar in both groups. During the 17-d period, we measured body composition by dual-energy X-ray absorptiometry scanning; fasting i.v. glucose tolerance tests (IVGTT) and hyperinsulinemic-euglycemic clamps (CLAMP) were performed to quantify insulin resistance. On d 17, tissue was collected after 1-h, low-dose CLAMP for tissue insulin signaling assays. TPN pigs gained less lean and more body fat and developed hepatic steatosis compared with EN pigs. After 7 and 13 d, IVGTT showed evidence of insulin resistance in the TPN compared with the EN group. Fasting plasma glucose and insulin also were higher in TPN pigs. CLAMP showed that insulin sensitivity was markedly lower in TPN pigs than in EN pigs. TPN also reduced the abundance of the insulin receptor, insulin receptor substrate 1, and phosphatidylinositol 3 kinase in skeletal muscle and liver and the proliferation of total pancreatic cells and β-cells. Hepatic proinflammatory genes as well as c-Jun-N-terminal kinase 1 phosphorylation, plasma interleukin 6, and tumor necrosis factor-α were all higher in TPN pigs than in EN pigs. The results demonstrate that chronic TPN induces a hepatic inflammatory response that is associated with significant insulin resistance, hepatic steatosis, and fat deposition compared with EN in neonatal pigs. Further studies are warranted to establish the mechanism of TPN-induced insulin resistance and hepatic metabolic dysfunction and whether there are persistent metabolic consequences of this lifesaving form of infant nutritional support.
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Affiliation(s)
- Barbara Stoll
- USDA/Agricultural Research Service Children's Nutrition Research Center, Baylor College of Medicine and Texas Children's Hospital, Houston, TX 77030, USA.
| | - David A. Horst
- Section of Neonatology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX 77030
| | - Liwei Cui
- USDA/Agricultural Research Service Children's Nutrition Research Center, Baylor College of Medicine and Texas Children's Hospital, Houston, TX 77030
| | - Xiaoyan Chang
- USDA/Agricultural Research Service Children's Nutrition Research Center, Baylor College of Medicine and Texas Children's Hospital, Houston, TX 77030
| | - Kenneth J. Ellis
- USDA/Agricultural Research Service Children's Nutrition Research Center, Baylor College of Medicine and Texas Children's Hospital, Houston, TX 77030
| | - Darryl L. Hadsell
- USDA/Agricultural Research Service Children's Nutrition Research Center, Baylor College of Medicine and Texas Children's Hospital, Houston, TX 77030
| | - Agus Suryawan
- USDA/Agricultural Research Service Children's Nutrition Research Center, Baylor College of Medicine and Texas Children's Hospital, Houston, TX 77030
| | - Ashish Kurundkar
- Departments of Pediatrics, Cell Biology, and Pathology, University of Alabama at Birmingham, Birmingham, AL 35294
| | - Akhil Maheshwari
- Departments of Pediatrics, Cell Biology, and Pathology, University of Alabama at Birmingham, Birmingham, AL 35294
| | - Teresa A. Davis
- USDA/Agricultural Research Service Children's Nutrition Research Center, Baylor College of Medicine and Texas Children's Hospital, Houston, TX 77030
| | - Douglas G. Burrin
- USDA/Agricultural Research Service Children's Nutrition Research Center, Baylor College of Medicine and Texas Children's Hospital, Houston, TX 77030,Section of Neonatology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX 77030
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18
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Should Routine Peripheral Blood Glucose Testing Be Done for All Newborns at Birth? MCN Am J Matern Child Nurs 2010; 35:264-70. [DOI: 10.1097/nmc.0b013e3181e4a739] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Hyman SJ, Novoa Y, Holzman I. Perinatal endocrinology: common endocrine disorders in the sick and premature newborn. Endocrinol Metab Clin North Am 2009; 38:509-24. [PMID: 19717002 DOI: 10.1016/j.ecl.2009.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Endocrine disorders are common in infants in the neonatal ICU. They often are associated with prematurity, low birth weight or very low birth weight, and small size for gestational age. They also frequently occur in infants who are critically ill or stressed. This article describes the most common conditions and current knowledge regarding management.
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Affiliation(s)
- Sharon J Hyman
- Division of Pediatric Endocrinology and Diabetes, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1616, New York, NY 10029, USA.
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20
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Alterations in glucose homeostasis in the pediatric intensive care unit: Hyperglycemia and glucose variability are associated with increased mortality and morbidity. Pediatr Crit Care Med 2008; 9:361-6. [PMID: 18496414 DOI: 10.1097/pcc.0b013e318172d401] [Citation(s) in RCA: 150] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Critically ill patients with alterations in glucose equilibrium may experience adverse outcomes. We sought to describe the distribution of blood glucose values in the absence of insulin therapy and to evaluate the association of hyperglycemia, hypoglycemia, and glucose variability with mortality and morbidity of critically ill children. DESIGN Retrospective cohort analysis. SETTING University-affiliated children's hospital pediatric intensive care unit (PICU). PATIENTS All children admitted to the PICU for >24 hrs with at least one blood glucose level recorded from a 1-yr period. Patients were excluded if >18 yrs of age, if insulin was administered during their PICU stay, and if the PICU admitting diagnosis included diabetes mellitus or hypoglycemia. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Patients were categorized with isolated hyperglycemia (blood glucose >or=150 mg/dL, [>or=8.3 mmol/L]), isolated hypoglycemia (blood glucose <or=60 mg/dL, [<or=3.3 mmol/L]), and glucose variability (both hyper- and hypoglycemia), and the associations with mortality, hospital length of stay, and nosocomial infections were assessed. Fisher's exact test, Kruskal-Wallis test, and logistic and linear regression were used to test for associations. Hyperglycemic and hypoglycemic measurements occurred in 56.1% and 9.7% of all patients, respectively. Glucose variability occurred in 6.8% of all patients. Glucose variability (odds ratio 63.6; 95% confidence interval, 7.8-512) and hyperglycemia (odds ratio 11.1; 95% confidence interval, 1.5-85.6) in the univariate analysis were associated with increased mortality. There were no deaths among patients with isolated hypoglycemia. Hyperglycemia and glucose variability were also associated with nosocomial infections (p = .01) and increased hospital length of stay (p < .001). Hypoglycemia and glucose variability occurred more commonly in younger patients (p < .001). CONCLUSIONS We found a relationship between blood glucose level and PICU patient outcomes. The relationship is similar to that found in adults and raises the question whether attention to control of blood glucose will improve outcomes in critically ill children.
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21
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Insulin infusion for the treatment of hyperglycemia in low birth weight infants: examining the evidence. Neonatal Netw 2008; 27:127-40. [PMID: 18431966 DOI: 10.1891/0730-0832.27.2.127] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
FORTY TO 80 PERCENT OF VERY LOW birth weight (VLBW) (infants <1,500 g) and extremely low birth weight (ELBW) (infants <1,000 g) infants will develop hyperglycemia when provided with glucose infusions adequate to meet basal metabolic needs.1,2 Avoiding hyperglycemia while providing adequate nutrition to promote growth and development is a major challenge for health care providers in the NICU. Some health care providers suggest that the judious use of continuous insulin infusion (CII) may provide the opportunity for increasing nutritional support while maintaining euglycemia. A systematic review of the literature is presented to evaluate the evidence supporting this practice.
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22
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Yeung MY. Glucose intolerance and insulin resistance in extremely premature newborns, and implications for nutritional management. Acta Paediatr 2006; 95:1540-7. [PMID: 17129959 DOI: 10.1080/08035250600658077] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
UNLABELLED Glucose intolerance and postnatal growth retardation are commonly seen in low-gestation newborns. In contrast to the nutrient compositions of parenteral and enteral nutrition, fetuses at equivalent gestational ages receive much more amino acids (protein) but less glucose and lipids through placental transfer. CONCLUSION A nutrition regime that simulates placental nutrient delivery would potentially minimize glucose intolerance and facilitate early attainment of normal growth velocity with normal body composition after preterm birth.
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Affiliation(s)
- Melinda Y Yeung
- Department of Pharmacy, The Children's Hospital at Westmead, New South Wales, Australia.
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23
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Lenclen R, Crauste-Manciet S, Narcy P, Boukhouna S, Geffray A, Guerrault MN, Bordet F, Brossard D. Assessment of implementation of a standardized parenteral formulation for early nutritional support of very preterm infants. Eur J Pediatr 2006; 165:512-8. [PMID: 16622662 DOI: 10.1007/s00431-006-0124-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2005] [Accepted: 02/28/2006] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Parenteral nutrition (PN) plays an important role in the nutritional support of very preterm newborns. It has been suggested that a high proportion of PN orders could be standardized. In 2002, we implemented in our unit the preparation of three standardized formulations for PN adapted to the nutritional requirements of premature infants<32 weeks. Following this change of practice, a retrospective observational study was conducted to evaluate the relevance of the implemented standardized PN regime. Twenty premature inborn infants<32 weeks gestation who had received standardized (STD) PN in 2003 were matched for 20 infants who had received individualized (IND) PN in 2001. Adequacy of nutrition was assessed by comparing daily intravenous nutrient intake and biochemical parameters during the first week. Amino-acid intakes on day 3 were higher in the STD group (1.5+/-0.2 g/kg/d vs. 0.9+/-0.5, p<0.001), and the calcium phosphate intakes were better balanced. The cumulated intake of amino acids for the first week was greater in the STD group (+20% ; p=0.0003). Biochemical parameters were similar in both groups. Insulin infusions were less frequent in the STD group (p<0.06). CONCLUSION Standardized parenteral formulations provided higher early intakes of amino acid and glucose, a better calcium phosphate ratio, and a greater amount of amino-acid intakes during the first week while maintaining the same biochemical parameters. This strategy forms part of an approach concerning quality control and the respect of good professional practice for the preparation of parenteral nutrition solutions.
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Affiliation(s)
- Richard Lenclen
- Division of Neonatology, Department of Pediatrics, Poissy-Saint Germain en Laye Hospital, and University of Pharmacy, Paris, France.
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24
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Wight N, Marinelli KA. ABM clinical protocol #1: guidelines for glucose monitoring and treatment of hypoglycemia in breastfed neonates. Breastfeed Med 2006; 1:178-84. [PMID: 17661596 DOI: 10.1089/bfm.2006.1.178] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Nancy Wight
- Children's Hospital and Health Center and Sharp Mary Birch Hospital for Women, San Diego, CA, USA
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25
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Abstract
Healthy, full-term infants are programmed to make the transition from their intrauterine constant flow of nutrients to their extrauterine intermittent nutrient intake without the need for metabolic monitoring or interference with the natural breastfeeding process. Homeostatic mechanisms ensure adequate energy substrate is provided to the brain and other organs, even when feedings are delayed. The normal pattern of early, frequent, and exclusive breastfeeding meets the needs of healthy full-term infants. Routine screening or supplementation are not necessary and may harm the normal establishment of breastfeeding. Screening should be restricted to at-risk and symptomatic infants. Symptomatic infants need immediate assessment and intravenous glucose therapy, not forced feedings.
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26
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Abstract
Neonatal hyperglycaemia, as usually defined (a whole blood glucose of >7 mmol/L), is common in the first week of life in babies born more than 12 weeks early. However, a review of a cohort of all such births in the north of England suggests that significant glycosuria is uncommon, and that there is no threat of an osmotic diuresis until the urine contains 2% glucose (by which time the blood glucose level almost always exceeds 15 mmol/L). The current statistical or epidemiological definition of hyperglycaemia (derived from data on term babies) needs to be replaced, for clinical purposes, by a more operationally relevant definition.
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Affiliation(s)
- Edmund Hey
- Retired Consultant Paediatrician, Newcastle, UK.
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27
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Claudius I, Fluharty C, Boles R. The Emergency Department Approach to Newborn and Childhood Metabolic Crisis. Emerg Med Clin North Am 2005; 23:843-83, x. [PMID: 15982549 DOI: 10.1016/j.emc.2005.03.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
For most emergency medicine physicians, the phrases "newborn workup" and "metabolic disease" are, at best, uncomfortable. This article, however, provides a simple approach to the recognition,evaluation, and treatment of infants with all manners of metabolic issues, including hypoglycemia, inborn errors of metabolism, jaundice, and electrolyte abnormalities. The disorders are grouped based on symptomatology, and have simple guidelines for work-up and management, with an emergency department practitioner perspective in mind.
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MESH Headings
- Acid-Base Equilibrium
- Adrenal Hyperplasia, Congenital/diagnosis
- Adrenal Hyperplasia, Congenital/metabolism
- Diagnosis, Differential
- Electrolytes/blood
- Emergency Service, Hospital
- Humans
- Hypoglycemia/diagnosis
- Hypoglycemia/drug therapy
- Hypoglycemia/physiopathology
- Infant, Newborn
- Infant, Newborn, Diseases/diagnosis
- Infant, Newborn, Diseases/therapy
- Jaundice, Neonatal/diagnosis
- Jaundice, Neonatal/physiopathology
- Jaundice, Neonatal/therapy
- Metabolism, Inborn Errors/diagnosis
- Metabolism, Inborn Errors/therapy
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Affiliation(s)
- Ilene Claudius
- Department of Emergency and Transport Medicine, Children's Hospital Los Angeles, 4650 Sunset Boulevard, MS113, Los Angeles, CA 90027, USA
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28
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Colletti JE, Homme JL, Woodridge DP. Unsuspected neonatal killers in emergency medicine. Emerg Med Clin North Am 2004; 22:929-60. [PMID: 15474777 DOI: 10.1016/j.emc.2004.06.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A neonate presenting to the emergency department can present a challenge to even the most experienced clinician. This article has focused on four deceiving and potentially devastating neonatal diseases. 1. Neonatal herpes is a potentially devastating illness without pathognomonic signs or symptoms. Early recognition and therapy can reduce mortality markedly. Although no specific sign or symptom is diagnostic,the diagnosis should be strongly considered in the presence of HSV risk factors, atypical sepsis, unexplained acute hepatitis, or focal seizure activity. Acyclovir therapy should be initiated before viral dissemination or significant CNS replication occurs. 2. Pertussis is a disease in which infants are at greatest risk of death or severe complication. Neonatal pertussis often presents in an atypical manner, lacking the classic signs and symptoms such as the "whoop."More common signs and symptoms include cough, feeding difficulty,low-grade fever, emesis, increasing respiratory distress, apnea, cyanosis,and seizures. Management should include hospitalization, supportive care, and antibiotics. 3. Congenital heart defects, particularly ductal-dependent lesions, may have an initial asymptomatic period that culminates in a rapidly progressive and fatal course. A neonate with CHD presents with shock refractory to volume resuscitation or pressor support. Resuscitative efforts are ineffective unless PGE, is administered. 4. Inborn errors of metabolism often are unsuspected because of their protean and heterogeneous nature. Signs and symptoms are subtle,are nonspecific, and often mimic other, more common diseases.An elevated index of suspicion, along with application and correct interpretation of a select few laboratory tests, is the key to making a diagnosis. Therapy is relatively straightforward and focused on resuscitation followed by prevention of catabolism and correction of specifically identified abnormalities. Although these disorders are relatively uncommon, prompt diagnosis and therapy can lead to a decrease in morbidity and mortality. The key is to maintain a high index of suspicion.
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MESH Headings
- Diagnosis, Differential
- Electrocardiography
- Electroencephalography
- Emergency Medicine/methods
- Emergency Treatment/methods
- Fluorescent Antibody Technique, Direct
- Heart Defects, Congenital/diagnosis
- Heart Defects, Congenital/epidemiology
- Heart Defects, Congenital/etiology
- Heart Defects, Congenital/therapy
- Herpes Simplex/diagnosis
- Herpes Simplex/epidemiology
- Herpes Simplex/etiology
- Herpes Simplex/therapy
- Humans
- Infant Mortality
- Infant, Newborn
- Infant, Newborn, Diseases/diagnosis
- Infant, Newborn, Diseases/epidemiology
- Infant, Newborn, Diseases/etiology
- Infant, Newborn, Diseases/therapy
- Intensive Care, Neonatal/methods
- Metabolism, Inborn Errors/diagnosis
- Metabolism, Inborn Errors/epidemiology
- Metabolism, Inborn Errors/etiology
- Metabolism, Inborn Errors/therapy
- Morbidity
- Neonatal Screening
- Oximetry
- Polymerase Chain Reaction
- Resuscitation/methods
- Risk Factors
- Time Factors
- United States/epidemiology
- Whooping Cough/diagnosis
- Whooping Cough/epidemiology
- Whooping Cough/etiology
- Whooping Cough/therapy
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Affiliation(s)
- James E Colletti
- Department of Pediatric and Adolescent Medicine, Mayo Medical School, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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29
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Cowett RM, Farrag HM. Selected principles of perinatal-neonatal glucose metabolism. ACTA ACUST UNITED AC 2004; 9:37-47. [PMID: 15013474 DOI: 10.1016/s1084-2756(03)00113-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2003] [Indexed: 10/27/2022]
Abstract
While the fetus is completely dependent on his/her mother for glucose and other nutrient transfer across the placenta, the adult is completely independent, especially one who is neither pregnant nor diabetic. The neonate is considered to be in a transition between the complete dependence of the fetus and the complete independence of the adult. The heterogeneity that is the hallmark of neonatal glucose metabolism is illustrated by the observation that maintenance of euglycaemia in the sick and/or low-birthweight neonate is especially difficult. This reinforces the concept that the neonate is vulnerable to carbohydrate disequilibrium. In this discussion, we shall first evaluate the definition of euglycaemia by considering the ranges for hypo- and hyperglycaemia. We shall also review the considerable literature that has been published on measurement of the rate of glucose production and the rate of glucose utilization in the neonate. This review highlights where further work is necessary to understand the developing maturation (i.e. control) of glucose homeostasis in the neonate.
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Affiliation(s)
- Richard M Cowett
- Department of Pediatrics, Northeastern Ohio Universities College of Medicine, Rootstown, OH, USA.
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