Neonatal Hyperglycemia: Everything You Need to Know

Introduction:

Neonatal hyperglycemia is a potentially severe condition that affects newborns in the first few days after birth. Parents must understand the causes, symptoms, diagnosis, and treatment of neonatal hyperglycemia. This article will discuss the causes, symptoms, diagnosis, and treatment.

What Is Neonatal Hyperglycemia?

Neonatal hyperglycemia is a condition in which there is an abnormally high level of glucose (sugar) in the blood of a newborn baby. It occurs when the baby’s pancreas fails to produce enough insulin to regulate the amount of glucose in the blood. The average blood glucose level is 70 to 150 milligrams per deciliter ( mg/dL). Neonatal hyperglycemia usually occurs when serum glucose is more than 150 mg/dL (8.3 millimoles/liter) or whole blood glucose is more than 125 mg/dL (6.9 millimoles/liter), irrespective of gestational or postmenstrual age.

What Is the Epidemiology of Hyperglycemia?

Preterm infants are more likely to have hyperglycemia, which usually manifests during the first week of life. Acute hyperglycemia resolves within two to three days but can last up to ten days. Hyperglycemia is less common in neonates than hypoglycemia but is associated with increased mortality and morbidity. Birth weight and gestational age are inversely related to neonatal hyperglycemia.

What Are the Causes of Neonatal Hyperglycemia?

An elevated blood sugar level in newborns characterizes neonatal hyperglycemia. It is a potentially serious condition that can cause long-term health complications if left untreated. There are several possible causes of neonatal hyperglycemia.

1. Iatrogenic Hyperglycemia: Iatrogenic hyperglycemia is the medical term for high blood sugar levels caused by medications or interventions administered by medical professionals. Medications such as steroids, diuretics, and some chemotherapy drugs can cause elevated blood sugar levels in newborns. Other medical interventions, such as intravenous (IV) fluids and nutrition, can also lead to iatrogenic hyperglycemia in infants.

2. Inability to Metabolize Glucose: Some newborns may have difficulty metabolizing glucose. They may occur due to an abnormality in the baby’s pancreas, which regulates blood sugar levels.

3. Impaired Glucose Homeostasis: When the body cannot regulate glucose homeostasis (the balance of glucose intake and energy expenditure), this can lead to neonatal hyperglycemia. In newborns, this may be caused by immaturity of the pancreas, high fat intake, and hypothyroidism (underactive thyroid).

4. Sepsis: A severe infection that can affect all body organs and systems, including the pancreas. Newborns with sepsis can develop elevated blood sugar levels due to impaired glucose metabolism.

5. Protein Intake In Early Periods: Newborns who receive excessive amounts of protein during the first few days of life may be at an increased risk for developing hyperglycemia. Protein can stimulate insulin secretion, leading to an increase in blood sugar levels.

6. Lipid Infusion: Hyperglycemia can develop even if the rate of glucose administration is low. Increased plasma-free fatty acid concentrations can cause hyperglycemia, which inhibits the peripheral use of glucose and the effects of insulin.

7.Increase Stress Hormones: Epinephrine and norepinephrine inhibit insulin secretion. They also increase glucagon, which promotes glycogenolysis and physiological stress conditions like surgery, pain, respiratory distress, or hypoxia (lack of oxygen).

8. Transient Neonatal Diabetes Mellitus: Occurs in early gestational age (SGA) infants. It is a self-limited condition.

9. Causes Related to Eternal Feeding: Delays in starting enteral feeding result in decreased incretin secretion, which leads to hyperglycemia.

10. Drugs-Related Hyperglycemia: Drug-related hyperglycemia can occur due to:

Maternal Medications:

• Maternal diazoxide can cause hyperglycemia, hypotension (decreased blood pressure), and tachycardia (increased heart rate) in neonates.

• Antenatal steroids.

Neonatal Medications:

• Dopamine.

• Caffeine.

• Theophylline.

• Phenytoin.

• Corticosteroids.

What Are the Symptoms of Neonatal Hyperglycemia?

The most common symptom of neonatal hyperglycemia is

• Poor feeding.

• Weight gain.

• Increased Thirst.

• Frequent Urination.

• Jitteriness (an involuntary movement frequent in the newborn).

• Irritability.

• Lethargy.

• Weak muscle tone.

• Signs of dehydration, such as sunken eyes, a dry mouth, a dry diaper for more than four hours, and no tears when crying.

What Are the Complications Associated With Neonatal Hyperglycemia?

• Hyperglycemia can cause intracranial hemorrhage by causing hyperosmolarity with osmotic shifts.

• An imbalance of electrolytes occurs due to osmotic diuresis.

• Dehydration due to osmotic diuresis.

• Prematurity retinopathy (eye disease in the baby).

• Bronchopulmonary disease (a chronic lung disease that affects the newborn).

• Poor wound healing.

• Impaired immunity and increased risk of sepsis.

• Insulin infusion raises the risks of hypoglycemia (low glucose in the blood) and hypokalemia (lower potassium level in the blood).

What Is the Diagnostic Approach to Neonatal Hyperglycemia?

1. Physical examination

A physical examination may reveal signs of the underlying cause, such as temperature instability and low perfusion. In addition, the following nonspecific symptoms may indicate hyperglycemia:

• Dehydration.

• Fever.

• Weight loss.

• Feeding difficulty.

• Increase urine output.

2. Laboratory Finding

• Serum Glucose Level: Before beginning treatment for neonatal hyperglycemia, a high blood glucose level must be confirmed by measuring the serum glucose level. Compared to capillary blood glucose measurement, venous blood glucose measurement is preferred. It is because capillary blood glucose levels are 15 % lower (heel stick sample), and the hematocrit value influences the levels.

• Glucose Detection in Urine (Glycosuria): Osmotic diuresis occurs when the urine glucose value is two (+) or higher. Each 18 mg/dL increase in blood glucose causes one milliosmole per liter (mOsm/L) increase in serum osmolarity. The normal osmolarity ranges between 280 and 300 mOsm/L.

3. Serum Electrolysis: Because of osmotic diuresis, hyperglycemia causes electrolyte loss in the urine. Electrolyte levels in hyperglycemic patients should be monitored.

4. Complete Blood Count: A complete blood count is essential for the differential diagnosis of sepsis.

5. Serum Insulin Level: Serum insulin levels in newborns with transient diabetes mellitus may be low or low to normal.

6. Serum And Urine C-Peptide Levels: These levels are used to differentiate between monogenic diabetes and Type 1 diabetes.

What Are the Treatment Plans for Neonatal Hyperglycemia?

The primary treatment for neonatal hyperglycemia is to regulate the infant’s blood glucose levels. This may be done by providing frequent and limiting feedings only when the infant is hungry. Breastmilk or formula is also helpful in keeping blood sugar steady. Most non-fed infants are given four mg/kg to six mg/kg/min intravenous glucose to maintain normal blood glucose levels. These neonates typically measure blood glucose every four to six hours.

1. Positive Glucose in Urine: If the infant's urine test results indicate positive glucose, the baby will need further treatment. There is a risk of osmolarity change when glucosuria is > one (+) in urine. If the urine glucose level is > two (+), the amount of glucose in the intravenous fluid is reduced by one to two mg/kg/min every two to four hours until the level is four mg/kg/min.

2. Negative Glucose in Urine: If the baby's urine test results indicate negative glucose in the urine, no further treatment is necessary. The parents should closely monitor the infant's diet and fluid intake to regulate their blood glucose levels. Additionally, if the infant's weight gain is inadequate, supplementation with formula or breast milk may be necessary. Blood and urine glucose should be monitored every four to six hours.

Conclusion:

Neonatal hyperglycemia is a potentially life-threatening condition that must be diagnosed and treated quickly to prevent further complications. Early recognition of signs and symptoms and proper management are essential for the health and safety of the newborn baby. Parents need to understand the causes, signs and symptoms, diagnosis, and treatment of neonatal hyperglycemia to better care for their baby. With early recognition and treatment, most babies with neonatal hyperglycemia fully recover.