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One of the most prevalent clinical concerns among extremely low birth weight babies is hyperglycemia. Hyper means high and glycemia is the term used for blood sugar levels. This means when there is too much sugar in the blood because the body lacks enough insulin, the condition is known as hyperglycemia – which is a body with less insulin and more sugar in the blood. When a newborn’s plasma glucose levels are abnormally high (145mg per dl), it is called neonatal hyperglycemia. This situation occurs when there is a lack of sufficient levels of insulin in the body.
Hyperglycemia in newborns may be caused because of infection, liver problems, hormone problems, and some medical side effects. Rarely, newborns may be born with diabetes, resulting in low insulin levels and high blood sugar levels.
Hyperglycemia in newborns is present in both term and preterm infants. This kind of high blood sugar occurs in newborns immediately after birth during the age of one month. Both male and female neonates are equally likely to develop hyperglycemia.
The condition may occur following IV glucose infusion, exchange transfusion of blood, and in anencephalic babies due to poor utilization of glucose. Glucose utilization is also reduced in meningitis, meningoencephalitis, and intracranial hemorrhage leading to elevation of blood glucose.
Extremely low birth weight babies may not utilize 10 percent dextrose, leading to hyperglycemia. Administration of certain drugs in preterm infants for management of apneic attacks may lead to hyperglycemia due to activation of liver enzymes.
Neonatal infections may rarely cause hyperglycemia by imposing added stress on an already impaired carbohydrate metabolism. This is because of the release of the hormone adrenaline and norepinephrine during stress response in infants, who are seriously not well or suffering from low birth weight. These hormones affect the liver to release glucose into the blood circulation, resulting in elevated blood sugar levels and hyperglycemia.
Diabetes in newborns during the first 6 months of life is another cause of infant hyperglycemia. It is caused because the infant cannot produce enough insulin. Low insulin levels lead to high blood glucose levels, which is another cause of newborn hyperglycemia.
Some of the risk factors for hyperglycemia in infants are:
* Infants born prematurely
* Atypical stress response to critical illness that can result in high blood sugar level
* Glucocorticoids therapy is a common treatment for low birth weight, which can lead to increased blood sugar.
* Development of neonatal diabetes mellitus or gestational diabetes mellitus (GDM).
* Several factors affect neonatal blood glucose such as gestational age, birth weight, Apgar score, hypoxia, maternal intake of steroids, the severity of illness, and sepsis.
The signs and symptoms of hyperglycemia in infants are usually not seen but one can identify hyperglycemia in infants. It is characterized by frequent and excessive urine, dehydration, and increased thirst. Infants with hyperglycemia may have no symptoms or have a delayed start of signs.
To monitor the infant’s blood sugar level, a blood test will be performed. This can be done with a heel or finger stick at the bedside or in a health care provider’s office or lab.
The treatment of hyperglycemia should include either lowering the amount of glucose given or initiating insulin therapy or both should be performed together. This can be managed by IV re-hydration and administration of insulin in a dose of 0.5 – 3 units per kg per day, given sub-cutaneously. This needs to be continued for a few weeks.
Early treatment of hyperglycemia in newborns is generally good. In many cases, there are no long-term effects on the newborns. It is very important to get in touch with the healthcare providers if any doubt occurs by observation.