GLUCOSE HOMEOSTASIS IN THE MICROPREMIE
Section snippets
EVALUATION OF GLUCOSE METABOLISM IN THE HUMAN NEONATE
The metabolic research in the human neonate is generally limited by several basic ethical constraints, as discussed in a recent review.7 First, the studies must be noninvasive or minimally so. Second, blood samples must invariably be small, particularly those obtained from the very low-birth weight (LBW) neonate. Third, given the limited direct access to most organ systems, the approaches used must allow extrapolation from the sampled data to events occurring in otherwise inaccessible areas.
EVALUATION OF THE RATE OF GLUCOSE PRODUCTION IN THE MICROPREMIE
During kinetic studies using stable isotopic methodology, glucose infusion, glucose absorbed from the gastrointestinal tract, glycogenolysis, and gluconeogenesis may collectively contribute to the rate of glucose appearance in the metabolic pool (i.e., plasma). Only the latter two variables reflect the endogenous rate of glucose production primarily from the liver.
The measurement of the true rate of glucose production usually gives a good estimate of the glucose requirement of the individual
EVALUATION OF GLUCOSE USE IN THE MICROPREMIE
It is important to recognize that glucose is used by a variety of tissues that have different metabolic characteristics5, 88: first, tissues that use glucose independent of insulin (e.g., brain); second, tissues that increase their glucose use with increments in plasma glucose concentration independent of increments in insulin concentration (e.g., liver, gut, and red blood cells); third, tissues that depend on insulin for glucose use (e.g., skeletal muscles and adipose tissues). It is also
OXIDATIVE AND NONOXIDATIVE DISPOSAL OF GLUCOSE IN THE MICROPREMIE
It is important not only to evaluate the overall ability of the micropremie to use glucose, but also to understand how glucose contributes to his or her energy metabolism. Glucose is generally used by either nonoxidative or oxidative disposal.16, 87 Nonoxidative disposal represents glucose that is used for structural or energy storage purposes; only glucose that is used by oxidative disposal contributes to the energy expenditure of the neonate.1, 87 In the larger preterm neonate, van Goudoever
ALTERED GLUCOSE HOMEOSTASIS IN THE MICROPREMIE: HYPOGLYCEMIA
Although there are literally hundreds of papers in the literature focusing on neonatal hypoglycemia, this subject remains quite controversial. Controversies continue to involve definition, method and site of sampling, symptoms, significance of asymptomatic status, management, and finally its effect on neurodevelopmental outcome.2, 90
ALTERED GLUCOSE HOMEOSTASIS IN THE MICROPREMIE: HYPERGLYCEMIA
In the micropremie continuous glucose infusion is always required to maintain homeostasis and prevent hypoglycemia. As was mentioned in the beginning of this article, the conundrum is that many neonates develop hyperglycemia during glucose infusion. Hyperglycemia is associated with many treatments that are presently considered the standard of care for the micropremie (e.g., administration of total parenteral nutrition and the use of dexamethasone for the treatment of bronchopulmonary dysplasia
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Developmental Physiology of Carbohydrate Metabolism and the Pancreas
2020, Maternal-Fetal and Neonatal Endocrinology: Physiology, Pathophysiology, and Clinical ManagementDevelopmental Physiology of Carbohydrate Metabolism and the Pancreas
2019, Maternal-Fetal and Neonatal Endocrinology: Physiology, Pathophysiology, and Clinical ManagementHyperglycemia in Extremely Preterm Infants—Insulin Treatment, Mortality and Nutrient Intakes
2018, Journal of PediatricsCitation Excerpt :Intrauterine growth might contribute to hyperglycemia, but SGA infants in our study did not experience hyperglycemia more often than non-SGA infants. Another possible, and perhaps parallel, explanation is the immaturity of the pancreatic β cells, which results in inadequate insulin production.24,25 Hyperglycemia in extremely preterm infants was previously associated with lower levels of adiponectin, possibly as a result of adipose tissue immaturity.26
Nutrition for the Extremely Preterm Infant
2017, Clinics in PerinatologyCitation Excerpt :Glucose is the main energy source in fetal life, and in early postnatal life, extremely preterm infants are at risk of altered glucose homeostasis.41 Early continuous glucose infusion is required to provide a continuous energy source to the brain and vital organs.42 Early provision of amino acid has been the focus of neonatal nutrition research, but the early provision of sufficient glucose and energy is equally important.
Insulin kinetics and the Neonatal Intensive Care Insulin–Nutrition–Glucose (NICING) model
2017, Mathematical BiosciencesCitation Excerpt :In adult intensive care even a single hypoglycaemic episode has been associated with increased risk of mortality [31–33], while in neonatal intensive care hypoglycaemia has been associated with adverse neurological outcomes [34,35]. Model-based methods for glycaemic control have been little investigated, due in part to the extremely fragile nature of this cohort and the subsequent limitations on invasive procedures and blood sample collection [36] that thus also limit the ability to identify parameters to validate more physiologically relevant and complex models. The aim of this study is twofold.
Role of Glucoregulatory Hormones in Hepatic Glucose Metabolism During the Perinatal Period
2017, Fetal and Neonatal Physiology, 2-Volume Set
Address reprint requests to Hussien M. Farrag, MD, Division of Newborn Medicine Department of Pediatrics, Baystate Medical Center, 759 Chestnut Street, Springfield, MA 01199
This work was supported in part by R01 27287 awarded by the National Institutes of Health NICHD (RMC).