Recent evidence that fasting glucose homeostasis is limited in newborns by an impairment in gluconeogenesis suggests that the high incidence of hypoglycemia (hypogly) in SGA neonates may reflect the extent of fasting imposed on them by nursery feeding practice. To evaluate the effect of early feeding on plasma glucose (glu) levels, 18 healthy SGA infants ( 10%ile, 35-41 wk gest) were nipple-fed at 3 hour (hr) intervals starting within 2 hrs after delivery. Glu was measured before each feeding for the first 25 hrs of life. 11 healthy SGA infants in whom feedings were routinely withheld until 8 hrs of age served as controls. Mean (±SEM) glu prior to feed #1 was 59±7mg/dl and then ranged between 63±4 and 73±5mg/dl. None of the 143 glu values was < 35mg/dl. Only 3/18 (17%) early fed infants had a glu < 40mg/dl (all prior to feed #1) vs 8/11 (73%) control infants (p=.02). After the first feed, none of the early fed infants had a glu < 40mg/dl. These data indicate that glu is maintained in SGA infants at higher levels in response to early feedings. The current definition of hypogly in SGA infants (glu < 25mg/dl), based on surveys of glu when feedings were routinely withheld for 24-72 hrs after birth, may underestimate the level of glu which is physiologically normal for these infants. The present study suggests that it is reasonable to raise the level of glu used to define hypogly in SGA neonates to that used in older children (40mg/dl).
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