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

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

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.

That think about the use of insulin for the hyperglicemia in extreme premature babies?

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.