Posted May 7, 200816 yr comment_1151 Dear collegues, In our NICU we find hyperlicemia in many premies. We find it in almost all the babies <25 weeks, but also in many >27-28 weeks. Our TPN protocol consists (in first day of life) in 6 mg/kg/min of glucose, 1g/kg of Intralipid 20% and 1 g/kg of AA. It's, more or less, similar of others TPN protocols. Do you resolve hyperglicemia reducing glucose administration before, or dou you start insuline immediately? Best regards Marcello De Filippo, MD Subintensive care unit University of Siena, Italy
May 10, 200816 yr Dear Marcello, we usually start with reducing glucose administration till 4 mg/kg/min. If patient need it for a long time, we administer insulin infusion 0,05-0,1 U/kg/h with increasing glucose administration. And check glucose level every 30 min. Routinely we estimate not only a glucosemia , but glucosuria too. Sometimes the reason of hyperglikemia in ELBW is lack of AA in PN. Best regards
May 12, 200816 yr Just a quick comment: our approach is to look for glucosuria. If there's no glucosuria we are generally conservative (leave things as they are) but reduce glucose administration. If blood glucose is much elevated and we find glucosuria, we may use insuline infusions, according to the NeoFax recommendation. But as Darya points out - beware of HYPOglycemia.
August 30, 200816 yr That think about the use of insulin for the hyperglicemia in extreme premature babies?
September 11, 200816 yr Hi, in aour NICU, we use insuline at first day of life if glycemia is > 1.7 g/l and there is glucosuria. at day one of life we reduce G to the minimal.
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