Difficulties in managing hyperglycemia in extremely low birth weight infants – case report

D.I. Vasilescu, A.M. Dan, L.A. Ştefan, M.M. Cîrstoiu

Rezumat: Introduction. Studies have shown that 60-80% of extremely low birth weight (ELBW) newborns develop hyperglycemia in the first two weeks of life. The cause is usually iatrogenic, through high rates of exogenous glucose infusion from total parenteral nutrition (TPN). Other mechanisms are represented by insulin resistance due to the immaturity of enzyme systems, increased hepatic production of glucose, the inability to inhibit gluconeogenesis, and by the effect of stressors through the action of catecholamines. Hyperglycemia generates multiple harmful effects, which can be reduced with the help of insulin therapy, optimizing growth and avoiding fluid overload. Materials and method. We present the case of three ELBW newborns with neonatal respiratory distress, who required surfactant and invasive mechanical ventilation, along with prolonged TPN. The newborns developed persistent hyperglycemia in the first weeks of life (plasma glucose above 180 mg/dl) despite the decrease in glucose concentration and infusion rate, requiring insulin infusion. Results. In all three cases, it was relatively difficult to control the plasma glucose levels. Weight gain was satisfactory, but the patients presented multiple severe complications. Conclusions. The management of metabolic complications of ELBW newborns is important due to the major implications in their prognosis and survival. A special interest has recently been given to the concept of cellular modulation in critical periods of development and the influence in the subsequent occurrence of some diseases. Extrauterine adaptation in ELBW newborns involves biochemical and metabolic adjustments, with immediate and long-term impact.
Cuvinte cheie: ELBW, insulin therapy, glucose, complications.