Instability of Glucose Values in Very Preterm Babies at Term Postmenstrual Age

• Published in: The Journal of pediatrics 2014-12, Vol.165 (6), p.1146-1153.e2
• Main Authors: Pertierra-Cortada, África, MD, Ramon-Krauel, Marta, MD, Iriondo-Sanz, Martín, MD, PhD, Iglesias-Platas, Isabel, MD, PhD
• Format: Article
• Language: English
• Subjects: Blood Glucose - analysis; Comorbidity; Enteral Nutrition; Female; Fetal Growth Retardation - epidemiology; Fetal Growth Retardation - physiopathology; Homeostasis - physiology; Humans; Hyperglycemia - epidemiology; Hypoglycemia - epidemiology; Infant, Premature - physiology; Male; Pediatrics; Risk Factors
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2014.08.029

Objective To determine if very preterm (VPT) babies are capable of maintaining glucose levels within normal ranges at or near term postmenstrual age. Study design Glucose levels were intermittently or continuously monitored during 48 hours in a cohort of 60 VPT infants near hospital discharge. Hypoglycemic (≤45 mg/dL, 2.5 mmol/L) and hyperglycemic (≥140 mg/dL or 7.8 mmol/L, severe if ≥180 mg/dL or 10 mmol/L) episodes were considered relevant if they lasted longer than 30 minutes. Feeding regimes followed current practice. Results With intermittent capillary, 2 hypoglycemic values and another 3 that were abnormally high were detected. With continuous monitoring, 6 babies (10.0%) had isolated hypoglycemia ≤45 mg/dL (2.5 mmol/L) (3 of them reaching 40 mg/dL, 2.2 mmol/L), 14 (23.3%) had isolated hyperglycemia, and 8 (13.3%) had episodes of both. The mean duration of hypoglycemia per patient was 2.8 ± 2.9 hours and 4.68 ± 4.35 hours in the case of hyperglycemia, with 12 infants becoming severely hyperglycemic. Of the 12 severely hyperglycemic patients, 5 also developed severe hypoglycemia. No specific characteristics identified the hypoglycemic babies. A history of intrauterine growth restriction ( P  = .037) and female sex ( P  = .063) seemed to increase the risk of severe hyperglycemia. Conclusions VPT infants continue to have abnormal glucose values, especially hyperglycemia, by the time of hospital discharge. No specific factors identify babies at higher risk for hypoglycemia, and intrauterine growth restriction and female sex seemed to predispose to hyperglycemia.