Glucose metabolism in the infant weighing less than 1100 grams,☆☆,,★★

Presented at the meeting of the Society for Pediatric Research, Baltimore, Md., May 1992.
https://doi.org/10.1016/S0022-3476(94)70212-8Get rights and content

Abstract

We studied the rate of endogenous glucose production and disappearance in a group of 10 clinically stable <1100 gm infants in the first week of life, using stable-isotope (6,6-2H-glucose) dilution analysis for a 2-hour study period. Plasma glucose and insulin concentrations at 2 hours were 5.4 ± 2.5 mmol/L (97 ± 15 mg/dl) and 71.4 ± 2.9 pmol/L, respectively, and did not change during the study period. The rate of glucose disappearance was 37 ± 10 μmol/kg (6.77 ± 0.55 mg/kg) per minute. The rate of endogenous glucose production was 12.3 ± 11 μmol/kg (2.22 ± 0.61 mg/kg) per minute. The exogenous glucose infusion rate was 25.2 ± 8.4 μmol/kg (4.54 ± 0.47 mg/kg) per minute. Endogenous glucose production was correlated with plasma glucose concentration (r = 0.76; p < 0.05) and the rate of glucose disappearance (r = 0.75; p < 0.05); plasma glucose concentration was correlated with the rate of disappearance (r = 0.87; p = < 0.01) and insulin concentrations (p < 0.05). We conclude that infants who weigh <1100 gm utilize three to four times more glucose per kilogram of body weight than adults, reflecting their higher ratio of brain to body weight. Endogenous glucose production provided only approximately one third of the glucose needed—a mandate for the exogenous infusion of glucose to prevent the development of hypoglycemia. (J PEDIATR 1994;125:283-7)

Section snippets

Subjects

Ten infants (five girls) appropriate in size for gestational age and with birth weights <1100 gm, who were patients in the intensive care nursery at Temple University Hospital, Philadelphia, Pa., were recruited for this study. In addition to birth weight, selection criteria included (1) hemodynamic stability (i.e., normal and stable blood pressure, good peripheral perfusion), (2) if an endotracheal tube was in place, the need for low levels of mechanical ventilatory support (defined as a peak

RESULTS

Data from the 60- and 120-minute periods are presented in Table I. Mean plasma insulin concentration at 120 minutes was 71.4 pmol/L and ranged from 21.5 to 114 pmol/L. Plasma glucose concentrations and 6,6,-2H-glucose enrichment did not change throughout the study period (Fig. 1).

Correlations between the measured and calculated variables at 120 minutes are presented in Table II. Endogenous production of glucose was correlated with the plasma glucose concentration (r = .076) and GRd (r = 0.75),

DISCUSSION

Using a stable-isotope tracer method, we investigated EGP and GRd in clinically stable <1100 gm infants. The average GRd of 37 μmol/kg (6.77 mg/kg) per minute was higher than any previously reported values for larger and more mature infants. Using glucose uniformly labeled with carbon 13 as tracer, Cowett et al.7 reported a GRd of 16.6 μmol/kg (3 mg/kg) per minute (range, 10 to 22.8 μmol/kg [1.8 to 4.1 mg/kg] per minute) in ten 2000 gm infants born at 34 weeks of gestation, who were studied

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From the Departments of Pediatrics and Internal Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania

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Supported by U.S. Public Health Service grants AG-07988 (G. Boden) and RR-349 (General Clinical Research Center) and a Clinical Research Grant from the American Diabetes Association (G. Boden)

Reprint requests: Eileen E. Tyrala, MD, Temple University Hospital, Broad and Ontario Streets, Philadelphia, PA 19140-5189.

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