Title: Infusion Rate of Glucose Is the Major Predictor of Hyeprglycemia in Very Premature Infants Receiving Total Parenteral Nutrition Author
Submitted to: Pediatric Research
Publication Type: Abstract Only
Publication Acceptance Date: April 12, 2004
Publication Date: June 5, 2004
Citation: Sunehag, A.L. 2004. Infusion rate of glucose is the major predictor of hyeprglycemia in very premature infants receiving total parenteral nutrition [abstract]. Pediatric Research. 55:381A. Technical Abstract: Background: Hyperglycemia is frequently occurring in very premature infants receiving total parenteral nutrition. In adult intensive care patients, hyperglycemia has been associated with increased mortality. Although no such data are available in premature infants, it is conceivable that nutritional treatment strategies should aim at maintaining sufficient energy intake, yet preventing hyperglycemia. Objective: To determine whether hyperglycemia in infants receiving standard total parenteral nutrition is primarily due to reduced capacity to suppress glucose production or to other factors e.g. infusion rate of glucose Design/Methods: 11 infants (0.962+/-0.049 g, 26.7+/-0.4 wks) were studied on day 4+/-1 of life while receiving total parenteral nutrition as ordered by the attending physician. Rates of glucose appearance and glucose production were measured by isotope dilution of [6,6-2H2]glucose during 8 h of isotope infusion. Stepwise regression was used to determine the effects of glucose production rate, infusion rates of glucose and lipids, and gestational age and weight on blood glucose concentration. Results: The blood glucose concentrations remained stable during the study period, averaging 92, 92, 95, 100, 116, 128, 141, 154, 202, 221, 227 mg/dL in the individual infants. Rate of plasma glucose appearance (glucose production + exogenous glucose) averaged 61.4+/-2.5 umol/kg min and of glucose production 6.7+/-0.8 umol/kg min. Infusion rate of glucose was the only predictor of blood glucose concentration (r=0.70; p<0.02) i.e. neither glucose production, gestational age, weight or infusion rate of lipids had any effect on blood glucose concentration. Even the smallest infants maintained normal triglyceride concentrations while receiving 3-3.8 g/kg d of lipids. Conclusions: Premature infants have reduced capacity to suppress glucose production independent of glucose infusion rate, but this is apparently not an important factor in causing hyperglycemia. Instead, infusion rate of glucose is the major predictor of blood glucose concentration. Thus, providing glucose at rates corresponding to normal glucose turnover rates (33-44 umol/kg min), while supplying parenteral lipids at 3-4g/kg d and amino acids at 3 g/kg d, would be a potential strategy to prevent hyperglycemia and provide a sufficient energy intake.