GLUCOSE HOMEOSTASIS IN THE MICROPREMIE

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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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    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).

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