Neonatal Glucose Metabolism

Neonatal Care of the Infant of the Diabetic Mother

“…Factors that influence the degree of hypoglycemia include previous maternal glucose homeostasis and maternal glycemia during delivery. (14) An pregnant woman whose diabetes is inadequately controlled would have stimulated the fetal pancreas to synthesize excessive insulin that may be readily released. Administration of intravenous dextrose during the intrapartum period that results in maternal hyperglycemia (glucose Ͼ125 mg/L [6.9 mmol/L]) will be reflected in the fetus and will exaggerate the neonate's normal postdelivery decline in plasma glucose concentration.…”

Capillary (Heelstick) versus Venous Blood Sampling for the Determination of Glucose Concentration in the Neonate

“…Neonatal glucose homeostasis, like many other systems, is considered to be in a developingstateof maturation, which is influenced not only by the developing hormonal, neural and enzymatic systems, but also by the clinical con ditions to which a neonate is subject [4], While it has been studied before [5], recently increas ing interest has focused on the accuracy and reliability of various modes of measurement of blood glucose concentration as well as the Determination of Glucose Concentration in the Neonate route from which samples are obtained [6,7], Relative to the former, in contrast to manufac turer's claims, glucose reflectance meters were judged not to be able to be used for the evalua tion of glucose concentration by capillary (heelstick) in the high risk neonate [7], Because frequent blood glucose monitor ing is required in the neonate, especially in the low birth weight or sick neonate to maintain euglycemia under conditions of developing maturation, capillary (heelstick) sampling is a frequent site from which blood is obtained to measure blood glucose concentration. There has been little documentation of the degree to which the neonatal pain response and the mechanical squeezing required might affect the blood glucose determination from that site.…”

“…Using pal mar sweating as a validated measure of the physiologic response of the neonate, Harpin and Rutter [2] noted that the use of a mechan ical lancet, the Autolet, was less painful than a manual heelprick in neonates undergoing rou-tine blood sampling for screening. In a Cibasponsored Foundation, the discussion em phasized the theoretical differences in glucose concentrations depending on the various sites from which blood is obtained, but provided no data [3], Because the neonate is in a state of developing glucose homeostasis and requires frequent blood glucose determinations, the site from which blood is obtained as well as the reliability of measurements of blood glu cose concentrations are of continuing concern and evaluation [4][5][6][7], The purpose of this study was to assess the degree to which the accuracy of blood glucose determinations might be affected by the use of capillary (heelstick) blood sampling in comparison to ve nous sampling.…”