Hyperglycaemia and Preterm Infants: A Chapter of its Own

Abstract

Antenatally, glucose maintenance takes place via transplacental transfer from mother to fetus. In the third trimester, the amount of glucose transported increases, while glycogen and fat stores are developed. After delivery a continuous and sufficient glucose supply for vital organs and brain is essential. In term infants hormonal and metabolic adaption is well-coordinated, involving adrenal gland, pancreas and liver. However, in preterm infants, mainly during first week of life, there is a high risk of abnormalities in glucose homeostasis. Due to limited glycogen and fat stores, hypoglycaemia may occur which is avoided by continuous glucose infusion. An underestimated risk is hyperglycaemia due to a combination of relative insulin deficiency and insulin resistance, associated with increased mortality and morbidity. Management of hyperglycaemia is one of the topics in neonatology and is still being discussed controversially. This review approaches different therapeutic strategies and gives an overview about the current recommendations in the literature.

Zusammenfassung

Während der Schwangerschaft erhält der Fetus die zu Aufrechterhaltung des Metabolismus und Wachstums notwendigen Glukosemengen diaplazentar über die Mutter. Im letzten Drittel der Schwangerschaft wird die diaplazentare Glukosemenge erhöht, während gleichzeitig Glykogen- und Fettspeicher angelegt und ausgebaut werden. Nach der Geburt ist eine kontinuierliche und suffiziente Glukoseversorgung für die Organe vor allem für das Gehirn essentiell. Bei reifen Neugeborenen erfolgt die hormonelle und metabolische Anpassung unter Einbeziehung der Nebenniere, des Pankreas und der Leber. Bei Frühgeborenen dagegen besteht vor allem in der ersten Lebenswoche ein hohes Risiko für eine gestörte Glukose-Homöostase. Aufgrund kaum vorhandener Glykogen- und Fettspeicher entsteht eine Hypoglykämieneigung, weshalb oft kontinuierlich Glukose intravenös verabreicht werden muss. Häufig wird eine reaktive Hyperglykämie beobachtet, die als Kombination aus relativem Insulinmangel und Insulinresistenz entsteht und mit einer erhöhten Mortalität und Morbidität einhergeht. Da Prävention und Behandlung der Hyperglykämie des Frühgeborenen ein in der Neonatologie kontrovers diskutiertes Thema ist, soll dieser Artikel die unterschiedlichen therapeutischen Strategien beleuchten und eine Übersicht über die aktuellen Empfehlungen in der Literatur geben.

Key words

glucose homeostasis - premature infants - hyperglycaemia

Schlüsselwörter

Glukose Homöostase - Frühgeborenes - Hyperglykämie

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