Glucose Homeostasis Disorders in Premature Infants

Abstract

An abnormal plasma glucose concentration is one of the most commonly encounter­ ed metabolic problems in the intensive care of premature infants. Compared with term infants, glycogen reserves are lower in the preterm neonatal liver. Despite this, preterm infants are at a greater risk of hyperglycemia than term infants are, which is owing to comparable production rate of endogenous glucose and impaired ability to reduce glucose production rate in response to hyperglycemia. Debate continues about the normal plasma glucose concentrations and the guideline for glucose con­ trol in pre mature infants. Some randomized controlled trials in very low birth weight infants demonstrated little clinical benefit of tight glycemic control with early insulin therapy and higher calorie intake in terms of mortality, morbidities and growth para­ meters. Compared with term infants, preterm infants have limited endocrine and metabolic adaptation to hypoglycemia. In any case, hypoglycemia in premature in­ fants should not be considered a physiologic condition. The operational criteria for intervention of hypoglycemia should be different from that in term infants. Con­ tinuous non­invasive glucose monitoring is a promising tool considering the principle of minimal handling of extremely premature infants. However, the clinical implication of abnor mal glucose concentrations, previously undetected on intermittent measure­ ments, is unclear.