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American Academy of Pediatrics
Article

Hyperglycemia in Extremely Preterm Infants

Sara Ramel and Raghavendra Rao
NeoReviews February 2020, 21 (2) e89-e97; DOI: https://doi.org/10.1542/neo.21-2-e89
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Sara Ramel
*Department of Pediatrics, Division of Neonatology, University of Minnesota, Minneapolis, MN
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Raghavendra Rao
*Department of Pediatrics, Division of Neonatology, University of Minnesota, Minneapolis, MN
†Center for Neurobehavioral Development, University of Minnesota, Minneapolis, MN
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  • Abbreviations:
    CGM:
    continuous glucose monitoring
    IVH:
    intraventricular hemorrhage
    OR:
    odds ratio
    ROP:
    retinopathy of prematurity
    VLBW:
    very low birthweight
  • Abstract

    Hyperglycemia after birth is common in extremely preterm infants (<28 weeks of gestation). Lower gestational age, lower birthweight, presence of severe illness, and higher parenteral glucose intake increase the risk for hyperglycemia, while provision of higher amounts of amino acids and lipids in parenteral nutrition and early initiation and faster achievement of full enteral feeding decrease the risk. Hyperglycemia is associated with increased mortality and morbidity in the neonatal period. Limited data show an association with long-term adverse effects on growth, neurodevelopment, and cardiovascular and metabolic health. Lowering the glucose infusion rate and administration of insulin are the 2 treatment options. Lowering the glucose infusion could lead to calorie deficits and long-term adverse effects on growth and neurodevelopment. Conversely, insulin use increases the risk for hypoglycemia and requires close blood glucose monitoring and frequent adjustments to glucose infusion and insulin dosage. Randomized trials of varying strategies of nutrient provision and/or insulin therapy and long-term follow-up are needed to improve clinical care and overall health of extremely preterm infants with hyperglycemia.

    • Copyright © 2020 by the American Academy of Pediatrics

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    NeoReviews
    Vol. 21, Issue 2
    1 Feb 2020
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    Hyperglycemia in Extremely Preterm Infants
    Sara Ramel, Raghavendra Rao
    NeoReviews Feb 2020, 21 (2) e89-e97; DOI: 10.1542/neo.21-2-e89

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    Hyperglycemia in Extremely Preterm Infants
    Sara Ramel, Raghavendra Rao
    NeoReviews Feb 2020, 21 (2) e89-e97; DOI: 10.1542/neo.21-2-e89
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