Difficulties in managing hyperglycemia in extremely low birth weight infants – case report

Abstract

Introduction. Studies have shown that 60-80% of ex­tremely low birth weight (ELBW) newborns develop hy­per­gly­ce­mia in the first two weeks of life. The cause is usually iatrogenic, through high rates of exogenous glu­cose infusion from total parenteral nutrition (TPN). Other mechanisms are represented by insulin resistance due to the immaturity of enzyme systems, increased he­pa­tic pro­duc­tion of glu­cose, the inability to inhibit glu­co­neo­ge­ne­sis, and by the ef­fect of stressors through the action of cate­cho­la­mines. Hy­per­gly­cemia generates multiple harmful effects, which can be reduced with the help of insulin therapy, op­ti­mizing growth and avoiding fluid overload. Materials and method. We present the case of three ELBW newborns with neonatal respiratory distress, who required surfactant and invasive mechanical ventilation, along with prolonged TPN. The newborns developed persistent hyperglycemia in the first weeks of life (plasma glucose above 180 mg/dl) de­spite the decrease in glucose concentration and infusion rate, requiring insulin infusion. Results. In all three cases, it was relatively difficult to control the plasma glucose le­vels. Weight gain was satisfactory, but the patients pre­sen­ted multiple severe complications. Conclusions. The ma­nage­ment of metabolic complications of ELBW new­borns is im­portant due to the major implications in their prognosis and survival. A special interest has recently been given to the concept of cellular modulation in critical pe­riods of de­velopment and the influence in the subsequent oc­cur­rence of some diseases. Extrauterine adaptation in ELBW newborns involves biochemical and metabolic ad­just­ments, with immediate and long-term impact.