Hyperglycemia is a serum glucose concentration > 150 mg/dL (>
The most common cause of neonatal hyperglycemia is
Iatrogenic
Iatrogenic causes usually involve too-rapid IV infusions of dextrose during the first few days of life in very low-birth-weight infants (< 1.5 kg).
The other important cause is physiologic stress caused by surgery, hypoxia, respiratory distress syndrome, or sepsis; fungal sepsis poses a special risk. In preterm infants, partially defective processing of proinsulin to insulin and relative insulin resistance may cause hyperglycemia.
In addition, transient neonatal diabetes mellitus is a rare, self-limited cause that usually occurs in small-for-gestational-age infants; corticosteroid therapy also may result in transient hyperglycemia. Hyperglycemia is less common than hypoglycemia, but it is important because it increases morbidity and mortality of the underlying causes.
Symptoms and Signs of Neonatal Hyperglycemia
Symptoms and signs of neonatal hyperglycemia are those of the underlying disorder.
Diagnosis of Neonatal Hyperglycemia
Serum glucose testing
Diagnosis of neonatal hyperglycemia is by serum glucose testing. Additional laboratory findings may include glycosuria and marked serum hyperosmolarity.
Treatment of Neonatal Hyperglycemia
insulin deficiency or insulin resistance.
insulininsulin can be adjusted without changing the total infusion rate. Responses to insulin are unpredictable, and it is extremely important to monitor serum glucose levels and to titrate the insulin infusion rate carefully.
In transient neonatal diabetes mellitus, glucose levels and hydration should be carefully maintained until hyperglycemia resolves spontaneously, usually within a few weeks.
Any fluid or electrolytes lost through osmotic diuresis should be replaced.
