Abstract
Background: Hyperglycemia occurs frequently in very premature infants receiving total parenteral nutrition (TPN). Commonly, the glucose infusion rates in TPN exceed the patient's glucose needs. In adult intensive care patients, accompanying hyperglycemia was associated with increased mortality. Since premature infants also represent a high-risk population, preventing hyperglycemia while providing sufficient energy intake may likewise reduce the risk of an adverse outcome.
Objective: To determine whether hyperglycemia in infants receiving standard TPN is primarily due to differences in their ability to suppress hepatic glucose production when presented with a high rate of exogenous glucose or to failure of the infant's disposal rate to match the intake.
Design/Methods: 11 clinically stable infants (962±49 g; 26.7±0.4 wks) were studied on day 4±1 of life while receiving TPN as ordered by the attending physician. Glucose production rate (GPR) was measured during an 8 h period of stable blood glucose using isotope dilution of [6,6–2H2]glucose. Multiple regression analysis was used to determine the effects of infusion rate of glucose, lipids and amino acids, residual GPR, gestational age and birth weight on blood glucose concentration.
Results: Range and median (within parenthesis) for each parameter: Blood glucose 5.3–12.6 (7.1) mM; Total glucose appearance rate (Ra) 8.9–13.1 (10.9) mg/kg min of which glucose infusion was 7.3–11.3 (9.5) mg/kg min and residual GPR 0.1–1.5 (1.4) mg/kg min; Infusion rate of lipids was 0.6–2.7 (2.1) mg/kg min and of amino acids 1.6–2.2 (2.0) mg/kg min. Glucose Ra explained 58% of the variation in blood glucose concentration (p<0.007), of which the glucose infusion rate accounted for the major part, 49% (p<0.02) and GPR for only 9% (p<0.05); gestational age explained 9% while infusion rates of amino acids and lipids, and birth weight did not affect blood glucose concentration. GPR was suppressed by 80% (assuming a normal glucose turnover rate of 6 mg/kg min).
Conclusion: In premature infants receiving TPN, the infusion rate of glucose is the strongest predictor of hyperglycemia, while residual GPR and gestational age have marginal impact. A potential clinical implication of these results is that a reduction of the glucose infusion rate while maintaining adequate supply of lipids and amino acids will reduce the incidence of hyperglycemia without compromising energy and protein balance. Grants: NIHRO1-HD37957–05; GCRCNIHHO1-RR-001888.
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Sunehag, A. 247 Infusion Rate of Glucose is The Major Predictor of Hyperglycemia in Very Premature Infants Receiving Total Parenteral Nutrition. Pediatr Res 56, 506 (2004). https://doi.org/10.1203/00006450-200409000-00270
Issue date:
DOI: https://doi.org/10.1203/00006450-200409000-00270
