Yaşar ŞEN, Neşe Çıtak KURT, Yaşar DOĞAN, Saadet AKARSU, A. Denizmen AYGÜN

Yenidoğanlarda hiperglisemi sıklığı ve nedenleri Orijinal Araştırma

Amaç: Yenidoğan bebeklerde hiperglisemi sıklığını ve gelişiminde etkili olan etmenleri ortaya koymak Gereç ve Yöntem: Çalışmaya 1 Ocak 1 Temmuz 2007 tarihleri arasında Fırat Üniversitesi Fırat Tıp Merkezi Yenidoğan Birimi’nde plazma glükoz düzeyi 8805;150 mg dl bulunan yenidoğanlar kabul edildi Olguların doğum öncesi doğum sırası doğum sonrasındaki özellikleri fizik muayene ve laboratuvar bulguları glükoz enfüzyon hızları aldıkları diğer tanıları tedavileri ve seyirleri kaydedildi Bulgular: Çalışma süresince izlenen toplam 435 hastadan 13’ünde 2 9 hiperglisemi tespit edildi Bu oran parenteral sıvı alan yenidoğanlarda 4 5’e ulaştı Hiperglisemi sıklığı erken doğmuş bebeklerde 5 2 düşük doğum ağırlığı olanlarda 6 5 çok düşük doğum ağırlıklılarda 13 9 ve aşırı derecede düşük doğum ağırlığı olanlarda ise 30 8 bulundu Hiperglisemili olguların tanı alma yaşı 4 2±4 1 gün gebelik haftası 33 2±5 1 hafta ve doğum ağırlıkları 2 248 46±1 450 62 gram idi Tanı anında ortalama plazma glükoz düzeyi 3 98 53±1 70 19 mg dl iken damardan glükoz enfüzyon hızı 4 8±2 0 mg kg dak bulundu Kan glükoz düzeyleri yaklaşık 15 8±10 8 saatte normale döndü Hiperglisemili olgularda hiperglisemiye eşlik eden sorunların başında erken doğum doğum asfiksisi respiratuvar distres sendromu ve sepsis gelmekteydi Çıkarımlar: Hiperglisemi yenidoğanlarda hastalanma ve ölüm açısından önemli bir risk etmeni olarak kabul edilmektedir Yenidoğan bebeklerde doğum ağırlığı ve gebelik haftası azaldıkça hiperglisemi sıklığı artmaktadır Damardan glükoz enfüzyonu uygulanan tüm bebeklerin glükoz düzeyleri sabit olana kadar kan glükoz düzeyleri yakından takip edilmelidir Türk Ped Arş 2008; 43: 55 8 Anahtar kelimeler: Düşük doğum ağırlığı erken doğmuş hiperglisemi yenidoğan

Anahtar Kelimeler:

Düşük doğum ağırlığı, erken doğmuş, hiperglisemi, yenidoğan

The prevalence and causes of hyperglycemia in newborns Original Article

Aim: The prospective study was performed to determine the prevalence and risk factors of hyperglycemia to newborns admitted in the neonatal unit nbsp; nbsp; nbsp; Material and Method: The newborns that had blood glucose levels gt;150 mg dl and referred to the Neonatal Unite Medical Center of Firat University between January 1 July 1 2007 were enrolled in the study Prenatal natal and postnatal histories examination and laboratory findings glucose infusion rates other diseases diagnosed and treatments received duration of hyperglycemia and prognosis of newborns with hyperglycemia were assessed Results: The prevalence of neonatal hyperglycemia was 2 9 during the study period Its prevalence rates were 4 5 5 2 6 5 13 9 and 30 8 respectively in newborns receiving parenteral glucose infusion preterm low birthweight very low birthweight and extremely low birthweight infants The mean diagnosis age mean gestational age and mean birth weight of those hyperglycemic neonates were 4 2±4 1 days 33 2±5 1 weeks and 2248 46±1450 62 g respectively The mean blood glucose level and mean intravenous glucose rate at the time of diagnosis was 398 53±170 mg dl and 4 8±2 0 mg kg min respectively The mean duration of hyperglycemia was 15 8±10 8 hours The most important risk factors associated with neonatal hyperglycemia were maturity birth asphyxia respiratory distress syndrome and sepsis respectively Conclusions: Hyperglycemia has become a significant risk factor for morbidity and mortality during the neonatal period The prevalence of hyperglycemia increases in newborn babies as the birthweight and gestational age of neonates decrease Blood glucose levels should be monitored daily in all infants who receive intravenous glucose infusions until blood glucose concentration becomes stable Turk Arch Ped 2008; 43: 55 8 Key words: Hyperglycemia newborn premature small gestational age

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McGowan JE, Perlman JM. Glucose management during and af- ter intensive delivery room resuscitation. Clin Perinatol 2006; 33: 183-96.
Yeung MY. Glucose intolerance and insulin resistance in extre- mely premature newborns, and implications for nutritional mana- gement. Acta Paediatr 2006; 95: 1540-47.
Stonestreet BS, Rubin L, Pollak A, Cowett RM, William O. Re- nal functions of low birth weight infants with hyperglycemia and glucosuria produced by glucose infusions. Pediatrics 1980; 66: 561-6.
Digiacomo JE, William W, Hary JR. Abnormal glucose homeosta- sis. In: Sinclair JC, Bracken MB (eds). Effective Care of Newborn Infant. First ed. New York: Oxford University Press, 1992: 591- 600.
Pildes RS, Lilien LD. Metabolic and endocrine disorders. In: Fa- naroff AA, Martin RJ (eds). Neonatal Perinatal Medicine. Fifth ed. Chicago: Mosby, 1992: 1152-79.
Blanco CL, Baillargeon JG, Morrison RL, Gong AK. Hyperglyce- mia in extremely low birth weight infants in a predominantly His- panic population and related morbidities. J Perinatol 2006; 26: 737–41.
Mitanchez D. Glucose regulation in preterm newborn infants. Horm Res 2007; 68:265-71.
Hovi P, Andersson S, Eriksson JG, et al. Glucose regulation in yo- ung adults with very low birth weight. N Engl J Med 2007; 356: 2053-63.
Meetze W, Bowsher R, Compton J, Moorehead H. Hyperglycemia in extremely-low-birth-weight infants. Biol Neonate 1998; 74: 214-21.
Kalhan SC, Parimi PS. Disorders of carbohydrate metabolism. In: Fanaroff AA, Martin RJ (eds). Neonatal-Perinatal Medicine: Disea- ses of the Fetus and Infant. Seventh ed. St. Louis: Mosby, 2002: 1351-75.
Louik C, Mitchell AA, Epstein MF, Shapiro S. Risk factors for ne- onatal hyperglycemia associated with 10% dextrose infusion. Am J Dis Child 1985; 139: 783-6.
Pati NK, Maheshwari R, Pati NK, Salhan RN. Transient neonatal hyperglycemia. Indian Pediatr 2001; 38: 898-901.
Cowett RM, William OH, Schwartz R. Persistent glucose produc- tion during glucose infusion in the neonate. J Clin Invest 1983; 71: 467-75.
Farrag HM, Cowett RM. Glucose homeostasis in the micropremie. Clin Perinatol 2000; 27: 1-22.
Sunehag A, Gustafsson J, Ewald U. Very immature infants (<30 week) respond to glucose infusion with incomplete suppression of glucose production. Pediatr Res 1994; 36: 550-5.
Saka N, Baş F. Yenidoğan hipoglisemi ve hiperglisemileri. Dağoğlu T (ed). Neonatoloji. Birinci baskı. İstanbul: Nobel Tıp, 2000: 639-43.
White RH, Frayn KN, Little RA, Threlfall CJ, Stoner HB, Irving MH. Hormonal and metabolic responses to glucose infusion in sepsis studied by the hyperglycemic glucose clamp technique. J Paren- ter Enteral Nutr 1987; 11: 345-53.
Kao LS, Morris BH, Lally KP, Stewart CD, Huseby V, Kennedy KA. Hyperglycemia and morbidity and mortality in extremely low birth weight infants. J Perinatol 2006; 26: 730-6.
Tyrala EE, Chen X, Boden G. Glucose metabolism in the infant weighing less than 1100 grams. J Pediatr 1994; 125: 283-7.
Soghier LM, Brion LP. Multivariate analysis of hyperglycemia in extremely low birth weight infants. J Perinatol 2006; 26: 723-5.
Lilien LD, Rosenfield RL, Baccaro MM, Pildes RS. Hyperglycemia in stressed small premature neonates. J Pediatr 1979; 94: 454-9.
Halliday HL, Ehrenkranz RA. Early postnatal (<96 hours) corticos- teroids for preventing chronic lung disease in preterm infants. Cochrane Database Syst Rev 2003; (1): CD001146.
al-Rubeaan K, Ryan EA. Phenytoin-induced insulin insensitivity. Diabet Med 1991; 8: 968-70.
Diderholm B, Ewald U, Gustafsson J. Effect of theophylline on glucose production and lipolysis in preterm infants (< or = 32 we- eks). Pediatr Res 1999; 45: 674-9.
Hays SP, Smith EO, Sunehag AL. Hyperglycemia is a risk factor for early death and morbidity in extremely low birth-weight in- fants. Pediatrics 2006; 118: 1811-8.
Wilkins BH. Renal function in sick very low birthweight infants: Glucose excretion. Arch Dis Child 1992; 67: 1162-5.
Edmund Hey. Glucose control in the perinatal period. Hypergl- ycaemia and the very preterm baby. Semin Fetal and Neonatal Med 2005; 10: 377-87.
Kairamkonda VR, Khashu M. Controversies in the management of hyperglycemia in the ELBW infant. Indian Pediatr 2008; 45: 29-38.
Alsweiler JM, Kuschel CA, Bloomfield FH. Survey of the manage- ment of neonatal hyperglycaemia in Australasia. J Paediatr Child Health 2007; 43: 632-3.
Collins JW Jr, Hoppe M, Brown K, Edidin DV. A controlled trial of insulin infusion and parenteral nutrition in extremely low birth we- ight infants with glucose intolerance. J Pediatr 1991; 118: 921-7.