Pathophysiology, diagnosis, and management of glucose homeostasis in the neonate

Cowett, Richard M.

doi:10.1016/0045-9380(85)90059-3

Cited by 15 publications

(6 citation statements)

References 139 publications

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“…15 In VLBW premature infants, the incidence of hyperglycemia is frequent because the endogenous production of glucose is not suppressed either by the exogenous intakes of nutrients or by the infusion of lipids. 16 Plasmatic values of triglycerides in the aggressive group were in the normal range, similar to that found by other authors. 17 When compared with the conventional group, improved energy intake in the aggressive group was not achieved at the expense of increased fluid intake.…”

Section: Discussionsupporting

confidence: 90%

Early and aggressive nutritional strategy (parenteral and enteral) decreases postnatal growth failure in very low birth weight infants

Dinerstein¹,

Nieto²,

Solana³

et al. 2006

J Perinatol

152

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Objective: To compare postnatal growth and nutritional deficits after the implementation of two different nutritional strategies in two consecutives periods of time.Methods: An early and aggressive nutritional regimen was used in a cohort of 117 very low birth weight (VLBW) infants. Amino acids were administered at the rate of 1.5 g/kg/day along with 5.6 mg/k/min of glucose flow on day 1 of life, and progressively increased to 4 g/kg/day and 13 mg/kg/min. Intravenous lipids were started at 0.5 g/kg/day at 24 h from birth, and increased to 3.5 g/kg/day; enteral feeding was begun at day 1 of life. Uni-and multivariate analyses were used to compare this group with the conventional group of 65 VLBW infants conservatively fed.Results: Univariate analysis showed that in the aggressive group there was a 66% reduction in the risk of post natal malnutrition at 40 weeks of postmenstrual age (OR 0.34; 95% CI 0.17-0.67). This difference persisted in the multivariate analysis. Energy and protein deficits were lower in the aggressive group (P<0.001).Conclusions: Early and aggressive introduction of total parenteral nutrition and enteral feeding resulted in better growth in weight, length and head circumference, and a reduction of nutritional deficits at 40 weeks of postmenstrual age.

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Section: Discussionsupporting

confidence: 90%

Early and aggressive nutritional strategy (parenteral and enteral) decreases postnatal growth failure in very low birth weight infants

Dinerstein¹,

Nieto²,

Solana³

et al. 2006

J Perinatol

152

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“…When inside the cell, lactate may contribute to the energy production by undergoing oxidative metabolism if an adequate oxygen supply is available (3 1). The immature blood-brain barrier in rats has a limited capacity for carriermediated glucose transport (25,29,32), and an increased lactate level offers an alternative energy substrate which can be advantageous, for example during short episodes of hypoglycemia (33).…”

Section: Discussionmentioning

confidence: 99%

Brain lactate in preterm and growth–retarded neonates

et al. 1995

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Glucose is the predominant cerebral energy source under physiological conditions, although other substrates may support cerebral metabolism. The present study was undertaken to determine if lactate is present in the immature human brain, and if so, whether or not concentrations of lactate differ between small-for-gestational-age and appropriate-for-gestational-age infants. Thirty stable, healthy infants with normal brains were investigated. As the only nutrient, all received milk enterally prior to the investigation, which was carried out without sedation. Mean gestational age was 35 completed weeks (range 28-41 weeks) and mean birth weight was 2170 g (range 855-4100 g). Proton nuclear magnetic resonance spectra from the striatal region were obtained while the infants were sleeping quietly. Lactate was present in all 10 preterm small-for-gestational-age and 10 of 13 preterm appropriate-for-gestational-age infants, and the concentration was inversely related to postmenstrual age (p < 0.002). In addition, lactate increased with the degree of growth retardation (p < 0.01). At present the significance of lactate is unclear. Lactate may be produced locally or in peripheral tissues, and may support brain metabolism.

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“…In spite of this, the rate of glucose production varied. This variation might be explained by differences in birth weight in relation to gestational age, respiratory illness, and treatment with theophylline as well as pre-and perinatal factors such as maternal disease or maternal pharmacologic treatment with tocolytic agents (23,24).…”

Section: Discussionmentioning

confidence: 99%

Glucose Production Rate in Extremely Immature Neonates (<28 Weeks) Studied by Use of Deuterated Glucose

et al. 1993

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ABSTRACT. Neonatal hypoglycemia is a frequent complication in immature infants. This may be due to small substrate stores, a high brain:body weight ratio, and immature enzyme systems. The purpose of the present study was to investigate the rate of glucose production in newborn infants with gestational ages of less than 28 wk. The subjects were 10 newborn infants delivered after 25 to 26 gestational wk. Their mean birth weight was 772 g (range 588-1000 g), and their mean postnatal age at the time of the study was 15 h (range 4-24 h). An isotopic compound (~-6,6-~H~-glucose) was given as a constant-rate i.v. infusion. In addition to dideuteroglucose, eight of the infants also received an i.v. infusion of unlabeled glucose at a rate of 1.4-2.6 m g kg-'. min-'. Blood samples for determination of the concentration and isotopic enrichment of plasma glucose were obtained every 15 min in a 2-h period. Isotopic enrichment, measured by gas chromatography/mass spectrometry, was used for calculating the glucose production rate. The mean glucose production rate related to body weight ( f SD) was 6.1 f 1.5 mg. kg-'. min-'. The results show that infants born at <28 gestational wk have a capacity to produce glucose on their 1st d of life at rates close to or even exceeding those reported in term infants. (Pediatr Res 33: 97-100, 1993) Abbreviations GPR, glucose production rate CV, coefficient of variation Ra, rate of appearanceThe transition from intrauterine to extrauterine life is accompanied by major alterations in fuel homeostasis. During pregnancy. the fetus is continuously supplied with glucose and amino acids from the mother. After birth. this transport of nutrients is interrupted, and the child has to mobilize fuel to meet the metabolic demands from vital organs, especially the brain. The immediate postpartum time is associated with hormonal changes. which stimulate glycogenolysis and gluconeogenesis (

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Pathophysiology, diagnosis, and management of glucose homeostasis in the neonate

Cited by 15 publications

References 139 publications

Early and aggressive nutritional strategy (parenteral and enteral) decreases postnatal growth failure in very low birth weight infants

Early and aggressive nutritional strategy (parenteral and enteral) decreases postnatal growth failure in very low birth weight infants

Brain lactate in preterm and growth–retarded neonates

Glucose Production Rate in Extremely Immature Neonates (<28 Weeks) Studied by Use of Deuterated Glucose

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