Abstract
In preterm infants low plasma glucose concentrations are frequently observed. We hypothesized that the infants' ability to adapt endogenous glucose production to diminishing exogenous supply is disturbed, but will improve with increasing gestational age. Glucose production rate and gluconeogenesis were measured using stable isotope techniques with [6,6-2H2]glucose and [2-13C]glycerol in 19 preterm infants (10 ≤ 30 wk and nine >30 wk gestational age) on d 5.0 ± 1.4 of life. Exogenous glucose was administered at a rate of 33 μmol·kg−1·min−1 followed by 22 μmol·kg−1·min−1. In the first 2 h after the decrease in exogenous supply, plasma glucose concentration declined comparably in both groups: ≤30 wk, from 4.3 ± 1.2 to 3.2 ± 0.9 mM; >30 wk, from 3.7 ± 0.7 to 3.0 ± 0.6 mM. Thereafter, only in infants >30 wk an increase was observed, to 3.4 ± 0.8 mM. Glucose production rate increased comparably in both groups: ≤30 wk, from 6.0 ± 4.1 to 8.8 ± 3.4 μmol·kg−1·min−1; >30 wk, from 7.8 ± 4.6 to 11.6 ± 5.2 μmol·kg−1·min−1. This increase was equivalent to approximately 30% of the decline in exogenous glucose. Gluconeogenesis increased comparably in both groups: <30 wk, from 3.2 ± 1.2 to 4.5 ± 1.3 μmol·kg−1·min−1; >30 wk, from 4.3 ± 1.9 to 6.8 ± 2.9 μmol·kg−1·min−1. We conclude that preterm infants can only partly compensate a decline in exogenous glucose supply by increasing endogenous glucose production rate, probably because of limitations in the final common pathway of intracellular glucose metabolism (i.e. glucose-6-phosphatase). The ability to maintain the plasma glucose concentration after a decrease in exogenous supply is better preserved in infants >30 wk owing to more efficient adaptation of peripheral glucose utilization.
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Abbreviations
- AGA:
-
appropriate for gestational age
- CI:
-
confidence interval
- GPR:
-
(endogenous) glucose production rate
- MIDA:
-
mass isotopomer distribution analysis
- Ra:
-
rate of appearance
- SGA:
-
small for gestational age
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Acknowledgements
The authors thank the participating children, their parents, and the medical and nursing staff of both neonatology departments for their cooperation. We thank G.J. Weverling, Ph.D., Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, Amsterdam, for his help with the statistical analysis.
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Van Kempen, A., Romijn, J., Ruiter, A. et al. Adaptation of Glucose Production and Gluconeogenesis to Diminishing Glucose Infusion in Preterm Infants at Varying Gestational Ages. Pediatr Res 53, 628–634 (2003). https://doi.org/10.1203/01.PDR.0000054733.13366.AF
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DOI: https://doi.org/10.1203/01.PDR.0000054733.13366.AF
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