Hyperglycaemia

 

 Reviewed by Jane Harding
January
2001
Clinical Guidelines Back Newborn Services Home Page
Complications Criteria for Insulin Exceptions to Insulin Management of Insulin References

Complications of Hyperglycaemia

  1. Undernutrition leading to growth failure
  2. Osmotic diuresis leading to dehydration
  3. Association with periventricular haemorrhage
  4. Exacerbation of hypoxic ischemic brain injury

Criteria for use of Insulin

Link to Insulin protocol

Tolerating <100 calories/kg/day
(see below for caloric calculations)    

AND

 Persistent glycosuria ≥ 2+
 or
Blood glucose ≥ 10mmols

Exceptions to Insulin Use

  1. First 72 hours of life
  2. Acute transient stress e.g. post surgery, acute sepsis etc.

Management of Insulin Infusion

  1. Administer in same line as intravenous fluids, so if there are any interruptions, both are interrupted together
  2. Starting dose usually 0.05units/kg/hr, then adjusted according to requirements
  3. Do not include insulin in the total daily fluid intake - it should be titrated on top of the prescribed fluid intake
  4. Monitor blood glucose, initially 2 hourly, and once stable at least 8 hourly
  5. Aim for blood glucose ≥4mmol with glycosuria ≤1+

Calorie Intakes

Thus a baby who is not tolerating 150ml/kg of P10 with 3g lipid, or 180ml/kg of P10 with 1g lipid would qualify for insulin infusion.

References

1 Binder ND, Raschko PK, Benda GI, Reynolds JW. Insulin infusion with parenteral nutrition in extremely low birth weight infants with hyperglycemia. J Pediatr 1989; 114: 273-80.
2 Collins JW, Hoppe M, Brown K, Edidin DV, Padbury J, Ogata ES. A controlled trial of insulin infusion and parenteral nutrition in extremely low birth weight infants with glucose intolerance. J Pediatr 1991; 118: 921-7.
3 Pildes RS. Neonatal hyperglycaemia. J Pediatr 1986; 109: 905-7