What is the appropriate infusion rate of D10 (dextrose 10%) for a neonate weighing 3.2 kg to achieve a glucose delivery rate of 4-6 mg/kg/minute?

From the Guidelines

For a 3.2 kg neonate requiring a glucose delivery rate of 4-6 mg/kg/minute using D10 solution, I recommend an infusion rate of 2.4-3.6 mL/kg/hour, which translates to a total infusion rate of 7.7-11.5 mL/hour. To calculate this, I used the formula: infusion rate (mL/kg/hour) = glucose delivery rate (mg/kg/min) × 60 min/hour ÷ 100 mg/mL (concentration of D10) 1. For the lower target of 4 mg/kg/min: 4 × 60 ÷ 100 = 2.4 mL/kg/hour, and for the upper target of 6 mg/kg/min: 6 × 60 ÷ 100 = 3.6 mL/kg/hour. When administering this infusion, it's crucial to monitor blood glucose levels regularly, especially during the first few hours, to ensure the neonate maintains appropriate glycemic control, as hyperglycaemia >8 mmol/L (145 mg/dL) should be avoided in neonatal ICU patients because it is associated with increased morbidity and mortality 1. Key considerations include:

• Monitoring blood glucose levels to prevent hyperglycaemia and hypoglycaemia
• Adjusting the infusion rate as needed to maintain the target glucose delivery rate
• Being aware of the potential risks of hyperglycaemia, such as increased morbidity and mortality, as highlighted in the guidelines 1. It's also important to note that insulin therapy may be necessary if reasonable adaptation of the glucose infusion rate is insufficient to control neonatal hyperglycaemia, as stated in the guidelines 1.

From the Research

Calculation of Infusion Rate for D10

To calculate the infusion rate of D10 (dextrose 10%) for a neonate weighing 3.2 kg to achieve a glucose delivery rate of 4-6 mg/kg/minute, we need to consider the following:

• The desired glucose delivery rate is 4-6 mg/kg/minute.
• The weight of the neonate is 3.2 kg.
• D10 is a 10% dextrose solution, which means it contains 10 grams of dextrose per 100 milliliters of solution.

Step-by-Step Calculation

• First, calculate the desired glucose delivery rate in milligrams per minute: 4-6 mg/kg/minute * 3.2 kg = 12.8-19.2 mg/minute.
• Since D10 contains 10 grams of dextrose per 100 milliliters, it contains 100 mg of dextrose per milliliter (10 grams = 10,000 mg, and 10,000 mg / 100 mL = 100 mg/mL).
• To deliver 12.8-19.2 mg of glucose per minute, we need to infuse 12.8-19.2 mg / 100 mg/mL = 0.128-0.192 mL/minute of D10.
• However, the provided studies do not directly address the calculation of infusion rates for D10 in neonates 2, 3, 4, 5, 6.

Available Information

• A study from 1977 found that constant glucose infusion at a rate of 8 mg/kg/minute was effective in treating neonatal hypoglycemia 2.
• Other studies discuss the use of oral dextrose gel for the treatment and prevention of neonatal hypoglycemia 3, 4, 5.
• A study from 1998 investigated hyperglycemia in extremely-low-birth-weight infants and compared two methods of treatment: continuous insulin infusion and reduction of glucose intake 6.

Infusion Rate Calculation

Based on the desired glucose delivery rate of 4-6 mg/kg/minute, we can estimate the infusion rate as follows:

• For a 3.2 kg neonate, the desired glucose delivery rate is 12.8-19.2 mg/minute.
• Assuming a 10% dextrose solution (D10), the infusion rate would be approximately 0.128-0.192 mL/minute, as calculated earlier.
• However, please note that this calculation is based on the available information and may not be directly supported by the provided studies.