neonatal hyperglycemia
Introduction
Introduction to neonatal hyperglycemia The characteristics of glucose metabolism in newborns are poor in the absorption of carbohydrates in milk and dairy products and the stability of glucose in blood, which is prone to hyperglycemia. Hyperglycemia refers to blood glucose >7mmo1/L (125mg/dl), or plasma glucose >8.128.40mmol/L (145150mg/dl) for hyperglycemia. Due to the low renal sugar threshold in neonates, diabetes often occurs when blood glucose is >6.7 mmol/L (120 mg/dl). basic knowledge The proportion of illness: the incidence rate is about 1% - 5% Susceptible people: children Mode of infection: non-infectious Complications: dehydration, diabetic ketoacidosis, intraventricular hemorrhage
Cause
Causes of neonatal hyperglycemia
Iatrogenic (27%):
Iatrogenic hyperglycemia is higher than other causes, usually in premature infants, mostly due to the speed of infusion of glucose solution is too fast or intolerable, iatrogenic causes more high blood sugar, mainly:
(1) Immature blood glucose regulation function: In neonates with poor glucose tolerance, especially premature infants and SGA infants, lack of Staub-Traugott effect in adults (ie, blood glucose level decline and glucose disappearance after repeated glucose transfusion) ), this is related to the insufficiency of islet B cell function, insensitivity to glucose input and poor insulin activity, small gestational age, low body weight and smaller age, the more obvious, the tolerance to sugar on the first day after birth The lowest, weight <1kg, even can not tolerate the glucose infusion rate of 5 ~ 6mg / (kg · min).
(2) Disease effects: Under stress conditions, such as asphyxia, cold and sepsis, the adrenal receptors may be excited, the release of catecholamines and glucagon may be increased, or the islet endocrine cells may be damaged and dysfunctional. It can cause hyperglycemia, which is mostly transient, but there are also a few that can last for a long time. For example, the neonates with hypothermia in the hypothermia group are more likely to have glucose clearance than those in the normal temperature group and the recovery group. Low, impaired glucose tolerance, decreased utilization of tissue glucose, which is associated with poor islet response, decreased insulin secretion, or decreased sensitivity of the receptor to insulin, and may also increase secretion of catecholamines, accelerate glycogen decomposition, or with high blood levels. Glucagon and cortisol levels are elevated, which is related to the enhancement of gluconeogenesis. It is reported that neonates with severe hypothermia, infection, and scleredema have significantly increased cortisol levels in plasma, and are easily associated with neonates. Glucose, central nervous system damage, the effect on blood glucose regulation is still unclear, may be associated with hypothalamic-pituitary function impairment, nerve, endocrine sugar The regulation function is caused by disorder.
(3) Others: iatrogenic hyperglycemia is often caused by excessive glucose infusion in premature and very low birth weight infants, or in total intravenous nutrition, exogenous sugar infusion can not inhibit endogenous sugar production, maternal delivery Sugar and glucocorticoids have been used for a short time before; infants have used hypertonic glucose, adrenaline and long-term use of glucocorticoids in the recovery of the delivery room, which have an effect on blood sugar levels; Activate liver glycogen breakdown and inhibit glycogen synthesis.
Neonatal temporary diabetes (30%):
Temporary neonatal diabetes is a rare self-limiting hyperglycemia, often occurring in children with small for gestational age, also known as neonatal pseudo-diabetes. The etiology and pathogenesis are not well understood, and may be related to islet B cell function. Temporarily low, some people report temporary diabetes; blood insulin levels are low, after recovery, it rises, about 1/3 of the children have a family history of diabetes, more common in SGA children, most of them occur within 6 weeks after birth, the course of disease Temporary, blood sugar is often higher than 14mmol / L (250mg / dl), weight loss, dehydration and urine sugar positive, urine ketone body is often negative or weakly positive, does not recur after healing, different from true diabetes.
True diabetes (10%):
Neonatal diabetes is rare.
Pathogenesis
Hyperglycemia is significant or long-lasting can occur hyperosmolaremia, increased plasma osmotic pressure, hypertonic diuretic, large loss of water and electrolytes, causing dehydration, polydipsia, polyuria, etc., even shock, due to neonatal intracranial vessel wall Poor development, severe hypertonicemia, intracellular fluid extravasation, cerebral vasodilation, increased blood volume, hypertonic dehydration of brain cells, severe cases can cause intracranial hemorrhage.
Prevention
Neonatal hyperglycemia prevention
Hyperglycemia is mainly iatrogenic and can also cause brain damage. Therefore, we should pay attention to the monitoring of blood sugar, to achieve prevention, early diagnosis and timely treatment, in order to reduce the incidence and reduce brain damage. The main measure of prevention is to control the speed of glucose input. The following points should be noted clinically:
1. Strengthen monitoring
(1) For neonates prone to hypoglycemia, blood glucose should be monitored at 3, 6, 9, 12, and 24 hours after birth, and hypoglycemia or hyperglycemia should be detected sooner or later.
(2) For those who have used glucose in the short time before delivery and when the newborn is resuscitated in the delivery room, check the blood glucose (using test strip method or micro blood sugar method) after entering the ward, and then determine the required sugar transfer rate.
2. Use hypertonic glucose with caution: In the case of neonatal asphyxia resuscitation and hypothermia, 25% hypertonic glucose should be used with caution. It is advisable to dilute the drug with 5% glucose. It should be considered that under stress, blood glucose is often not Low, and easy to have high blood sugar.
3. Adjust the speed and concentration of glucose: For high-risk children and premature infants, the glucose infusion rate should be controlled, and blood glucose monitoring should be done. If the increase is high, the input concentration and speed should be reduced immediately, and the infusion should not be stopped to prevent reactive hypoglycemia.
4. Parenteral nutrition: For newborns who are undergoing parenteral nutrition, supplemental calorie cannot be solved by increasing glucose concentration alone. A variety of amino acid solutions and lipidoids should be added to achieve total intravenous nutrition.
5. For low birth weight infants and high-risk children who can eat after birth, they should be fed sooner or later. Feeding sugar or milk from 2 to 4 hours after birth can not be fed by oral or nasal feeding. Intravenous infusion of glucose to maintain nutrition.
Complication
Neonatal hyperglycemia complications Complications dehydration diabetic ketoacidosis intraventricular hemorrhage
Hyperglycemia, dehydration, and ketoacidosis may occur in children with significant or long-lasting blood glucose. In severe hypertonicemia, intracranial hemorrhage and intraventricular hemorrhage may occur.
Symptom
Neonatal hyperglycemia symptoms Common symptoms Diabetes polydipsia Multi-drinking ketoacidosis Weight loss Multi-urine dehydration Intracranial hemorrhage Eyelid closure
Hyperglycemia is not serious, there is no clinical symptoms, and patients with markedly high blood sugar or long duration may have dehydration, polydipsia, polyuria, etc., showing a unique appearance, eye closure is not strict, accompanied by panic, weight loss, plasma osmotic pressure Increased, severe cases can occur intracranial hemorrhage, often appear diabetes, urine ketone body positive, may be associated with ketoacidosis.
Examine
Examination of neonatal hyperglycemia
1. Increased blood sugar: The diagnostic criteria for neonatal hyperglycemia are not yet unified. Scholars use blood glucose higher than 7,7.8,8.0mmol/L (125,140,145,150mg/dl) as the standard for hyperglycemia. Domestic scholars mostly use whole blood glucose >7mmo1/L (125mg/dl) as the diagnostic criteria. It is reported that intraventricular hemorrhage is prone to occur when the blood glucose of premature infants is >33.6mmol/L (600mg/dl).
2. Urine ketone body: true diabetes mellitus is often positive, may be associated with ketoacidosis, iatrogenic hyperglycemia or temporary diabetes, urine ketone body is often negative or weakly positive.
3. Urine sugar: Due to the low renal sugar threshold in neonates, diabetes often occurs when blood glucose is >6.7mmol/L (120mg/dl).
B-ultrasound, X-ray and brain CT examination if necessary.
Diagnosis
Diagnosis and diagnosis of neonatal hyperglycemia
diagnosis
Because neonatal hyperglycemia often has no specific clinical manifestations, the diagnosis is mainly based on blood glucose and urine glucose testing, but the cause should be identified in time to facilitate treatment. According to clinical features and related medical history, laboratory tests for whole blood glucose > 7mmo1/L ( 125mg/dl) can be diagnosed as hyperglycemia.
Differential diagnosis
Different from other causes of dehydration and neonatal intracranial hemorrhagic disease, neonatal intracranial hemorrhage is mainly caused by hypoxia and birth injury, medical history and laboratory tests, brain CT examination can help identify.
