Persistent long-term hyperglycemia in a premature newborn: clinical example

Abstract

Objective. To analyze the clinical picture of premature baby A. with persistent hyperglycemia, the patient's treatment tactics and approaches to differential diagnosis of the causes of this pathological condition. Glucose occupies one of the central positions in the processes of fetal growth and development, timely and normal development of the newborn brain. Disorders of its metabolism often lead to hypo- or hyperglycemia, especially common among premature infants, from isolated episodes to long-lasting persistent conditions. This article discusses a clinical case of a patient with registration of persistent hyperglycemia for two months.

Materials and methods. The article presents the analysis of the treatment of premature patient A. with a birth weight of 450 g. Medical documents with the results of clinical, instrumental and laboratory research methods were used. Informed consent of legal representatives for examination and treatment was obtained.

Results. A change in the condition of the child against the background of deep prematurity, septic process, accompanied by prolonged episodes of hyperglycemia, oxygen dependence, episodes of anemia, the formation of retinopathy and bronchopulmonary dysplasia, is described.

Conclusions. The analysis of the clinical case showed that hyperglycemia in premature infants is a polyetiological condition, it has different duration and outcomes, can be both the main disease as well as manifestation of many other serious pathologies of the neonatal period. The further search for effective and safe methods of diagnosis and correction of hyperglycemia is justified.

Keywords

premature newborn / hyperglycemia / immaturity / insulinotherapy

References

[1] Sheybak L.N. Clinical and metabolic features of the adaptation of newborns in the early neonatal period: Ph.D. dis … doc. med. nauk. Saint Petersburg 2011; 16 (in Russian).

[2] Шейбак Л.Н. Клинико-метаболические особенности адаптации новорожденных детей в ранний неонатальный период: автореф. дис … д-ра мед. наук. СПб. 2011; 16.

[3] Kadymova I.I., Bochkova L.G. Serum iron content in newborns with low birth weight. Рostgraduate doctor 2014; 3: 77–83 (in Russian).

[4] Кадымова И.И., Бочкова Л.Г. Содержа-ние сывороточного железа у новорожденных с малой массой тела при рождении. Врач-аспирант 2014; 3: 77–83.

[5] Biological chemistry.: textbook. allowance for students. medical universities of doctors of all specialties. Ed. I. Nikolaev. Moscow: Medical information agency 2004; 248–251 (in Russian).

[6] Биологическая химия.: учеб. пособие для студ. мед вузов врачей всех специальностей. Под ред. А.Я. Николаева. М.: Медицинское информационное агентство 2004; 248–251.

[7] Ivanov D.O. Glucose metabolism disorders in newborns. Children's medicine of the North-West 2011; 1: 68–91 (in Russian).

[8] Иванов Д.О. Нарушения обмена глюкозы у новорожденных. Детская медицина Северо-Запада 2011; 1: 68–91.

[9] Ditzenberger G.R., Collins S.D., Binder N. Continuous insulin intravenous infusion therapy for VLBW infants. J Perinat Neonatal Nurs. 1999; 13 (3): 70–82.

[10] Ustinovich Yu.A., Sapotnitsky A.V. Features of the perinatal period and the risk of cerebral hemorrhage in premature babies. Reproductive health. Eastern Europe 2013; 3: 80–88 (in Russian).

[11] Устинович Ю.А., Сапотницкий А.В. Особенности перинатального периода и риск развития церебральных кровоизлияний у недоношенных детей. Репродуктивное здоровье. Восточная Европа 2013; 3: 80–88.

[12] Markova O. Yu., Ionov O.V. Optimization of the treatment of hyperglycemia in premature infants. Neonatology: news, opinions, training 2019; 1: 7–11 (in Rus-sian).

[13] Маркова О.Ю., Ионов О.В. Оптимизация лечения гипергликемии у недоношенных детей. Неонатология: новости, мнения, обучение 2019; 1: 7–11.

[14] Kuraeva T.L., Emelyanov A.O. Clinical and genetic heterogeneity of neonatal diabetes mellitus. Diabetes Mellitus 2009; 10 (in Russian).

[15] Кураева Т.Л., Емельянов А.О. Клиническая и генетическая гетерогенность неонатального сахарного диабета. Сахарный диабет 2009; 10.

[16] Utz I.A., Shabarov V.K. Permanent neonatal diabetes mellitus: a clinical observation. Saratov Scientific Medical Journal 2015; 11 (2): 160–164 (in Russian).

[17] Утц И.А., Шабаров В.К. Перманентный неонатальный сахарный диабет: клиническое наблюдение. Саратовский научно-медицинский журнал 2015; 11 (2): 160–164.

[18] Kamalova A.A. Updated European recommendations for the introduction of complementary foods in children – a topic for reflection. Russian Bulletin of Perinatology and Pediatrics 2017; 62 (6) 96: 91–98 (in Russian).

[19] Камалова А.А. Обновленные европейские рекомендации по введению прикорма у детей – тема для размышлений. Российский вестник перинатологии и педиатрии 2017; 62 (6) 96: 91–98.

[20] Louik C., Mitchell A.A., Epstein M.F., Shapiro S. Risk factors for neonatal hyperglycemia associated with 10 % dextrose infusion. Am J Dis Child. 1985; 139 (8): 783–786.

[21] Meetze W., Bowsher R., Compton J., Moorehead H. Hyperglycemia in extremely-low-birth-weight infants. Biol Neonate. 1998; 74 (3): 214–221.

[22] Sunehag A., Gustafsson J., Ewald U. Very immature infants (< or = 30 Wk) respond to glucose infusion with incomplete suppression of glucose production. Pediatr Res. 1994; 36 (4): 550–555.

[23] White R.H., Frayn K.N., Little R.A., Threlfall C.J., Stoner H.B., Irving M.H. Hormonal and metabolic responses to glucose infusion in sepsis studied by the hyperglycemic glucose clamp technique. JPEN J Parenter Enteral Nutr. 1987; 11 (4): 345–353.

[24] White R.H., Frayn K.N., Little R.A., Threl-fall C.J., Stoner H.B., Irving M.H. Hormonal and metabolic responses to glucose infusion in sepsis studied by the hyperglycemic glucose clamp technique. JPEN J Parenter Enteral Nutr. 1987; 11 (4): 345–353.

[25] Manzoni P., Castagnola E., Mostert M., Sala U., Galletto P., Gomirato G. Hyperglycaemia as a possible marker of invasive fungal infection in preterm neonates. Acta Paediatr. 2006; 95 (4): 486–493

[26] Manzoni P., Castagnola E., Mostert M., Sala U., Galletto P., Gomirato G. Hyperglycaemia as a possible marker of invasive fungal infection in preterm neonates. Ac-ta Paediatr. 2006; 95 (4): 486–493.

[27] Doyle L.W., Cheong J.L., Ehrenkranz R.A., Halliday H.L. Early (< 8 days) systemic postnatal corticosteroids for prevention of bronchopulmonary dysplasia in preterm infants. Cochrane Database Syst Rev. 2017; 10 (10): CD001146.

[28] Srinivasan G., Singh J., Cattamanchi G., Yeh T.F., Pildes R.S. Plasma glucose changes in preterm infants during oral theophylline therapy. J Pediatr. 1983; 103 (3): 473–476.

[29] al-Rubeaan K., Ryan E.A. Phenytoin-induced insulin insensitivity. Diabet Med. 1991; 8 (10): 968–970.

[30] Rozance P.J. Neonatal hyperglycemia. NeoReviews 2010; 11: e632.

[31] Rozance P.J. and. Neonatal hyperglycemia. NeoReviews 2010; 11: e632.

[32] Yunusova S.E., Borodina O.I., Zholilova Z.Kh. Assessment of pain in newborns born in asphyxia according to the results of a survey of medical personnel and the NIPS scale during invasive manipulations. Young scientist 2016; 2 (106): 414–417 (in Russian).

[33] Юнусова С.Э., Бородина О.И., Жолилова З.Х. Оценка боли у новорожденных, рожденных в асфиксии, по результатам опроса медицинского персонала и шкале NIPS при инвазивных манипуляциях. Молодой ученый 2016; 2 (106): 414–417.

[34] Solodkova I.V., Melnikova L.N., Parshina N.V. and others. Children of mothers with diabetes mellitus. Diabetes mellitus in newborns. Clinical guidelines. 2016 (in Russian).

[35] Солодкова И.В., Мельникова Л.Н., Паршина Н.В. и др. Дети от матерей с сахарным диабетом. Сахарный диабет у новорожденных. Клинические рекомендации 2016.

[36] Alexandrou G., Skiöld B., Karlén J. et al. Early hyperglycemia is a risk factor for death and white matter reduction in preterm infants. Pediatrics. 2010; 125 (3): e584–e591.

[37] Kao L.S., Morris B.H., Lally K.P., Stewart C.D., Huseby V., Kennedy K.A. Hyperglycemia and morbidity and mortality in extremely low birth weight infants. J Perinatol. 2006; 26 (12): 730–736.

[38] Hays S.P., Smith E.O., Sunehag A.L. Hyperglycemia is a risk factor for early death and morbidity in extremely low birth-weight infants. Pediatrics. 2006; 118 (5): 1811–1818.

[39] Zamir I., Tornevi A., Abrahamsson T. et al. Hyperglycemia in Extremely Preterm In-fants-Insulin Treatment, Mortality and Nutrient Intakes. J Pediatr. 2018; 200: 104–110.e1.

[40] Zamir I., Tornevi A., Abrahamsson T. et al. Hyperglycemia in Extremely Preterm Infants-Insulin Treatment, Mortality and Nutrient Intakes. J Pediatr. 2018; 200: 104–110.e1.

[41] Yoo H.S., Ahn S.Y., Lee M.S. et al. Permissive hyperglycemia in extremely low birth weight infants. J Korean Med Sci. 2013; 28 (3): 450–460.

[42] Blanco C.L., Baillargeon J.G., Morrison R.L., Gong A.K. Hyperglycemia in extremely low birth weight infants in a predominantly Hispanic population and related morbidities. J Perinatol. 2006; 26 (12): 737–741.

[43] Zamir I., Stoltz Sjöström E., Ahlsson F., Hansen-Pupp I., Serenius F., Domellöf M. Neonatal hyperglycaemia is associated with worse neurodevelopmental outcomes in extremely preterm infants. Arch Dis Child Fetal Neonatal Ed. 2021; 106 (5): 460–466.

[44] Steinkuller P.G., Du L., Gilbert C., Foster A., Collins M.L., Coats D.K. Childhood blindness. J AAPOS. 1999; 3 (1): 26–32.

[45] Good W.V., Hardy R.J., Dobson V. et al. The incidence and course of retinopathy of prematurity: findings from the early treatment for retinopathy of prematurity study. Pediatrics. 2005; 116 (1): 15–23.

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