From the Guidelines
Glucose feeding is recommended for premature infants, with a typical starting rate of 4-6 mg/kg/min of glucose infusion, which can be increased to 8-10 mg/kg/min as needed based on blood glucose monitoring, as stated in the espghan/espen/espr/cspen guidelines on pediatric parenteral nutrition: carbohydrates 1. The guidelines recommend that preterm newborns receive parenteral glucose supply in the range of 4-12 mg/kg per min (5.8-17.3 g/kg per day), with a target of 8-10 mg/kg per min (11.5-14.4 g/kg per day) from day 2 onwards 1. For term newborns, the recommended parenteral glucose supply is 2.5-12 mg/kg per min (3.6-17.3 g/kg per day), with a target of 5-10 mg/kg per min (7.2-14.4 g/kg per day) from day 2 onwards 1. It is essential to avoid hyperglycemia, which can increase morbidity and mortality in pediatric ICU patients, and to maintain blood glucose levels between 45-120 mg/dL (2.5-6.7 mmol/L) 1. Excessive glucose intake should also be avoided, as it can lead to hyperglycemia, lipogenesis, and fat tissue deposition, as well as increased CO2 production and minute ventilation 1. The amount of glucose to be provided by parenteral nutrition should be guided by the balance between meeting energy needs and the risks of overfeeding/excess glucose load, phase of illness, macronutrient supply from enteral and parenteral nutrition, and glucose administered outside enteral and parenteral nutrition 1. Some key points to consider when glucose feeding premature infants include:
- Monitoring blood glucose levels every 2-4 hours initially, then less frequently as the infant stabilizes
- Gradually introducing enteral feedings with breast milk or specialized premature infant formula while reducing parenteral glucose
- Avoiding hyperglycemia and maintaining blood glucose levels within the recommended range
- Individualizing carbohydrate intake based on the infant's specific needs and medical condition.
From the Research
Glucose Feeding in Premature Infants
- Premature infants are at high risk of abnormal glucose homeostasis due to limited glycogen and fat stores 2.
- Continuous glucose infusion is often required soon after birth to maintain glucose levels, but this can lead to hyperglycemia in some cases 2.
- Defective islet beta-cell processing of proinsulin and partial resistance to insulin may contribute to hyperglycemia in preterm infants 2.
Parenteral Nutrition in Premature Infants
- Early commencement of parenteral nutrition may improve physical growth in very premature infants, but high doses of amino acids (>3.5 g/kg/day) may cause metabolic acidosis and other complications 3.
- Delaying parenteral nutrition until day 8 of admission may increase the risk of hypoglycemia 3.
- The benefits of commencing parenteral nutrition on the first day of life may outweigh the risks in very premature infants, but careful monitoring of blood glucose and other parameters is essential 3.
Feeding Types and Hypoglycemia Outcomes
- The type of feeding provided with dextrose gel can impact hypoglycemia outcomes, with formula and donor milk feedings associated with lower odds of recurrent hypoglycemia 4.
- Donor milk and formula feedings may raise blood sugar concentrations, but the impact differs by gestational age 4.
- A supplementation-based hypoglycemia guideline including donor milk may reduce NICU admissions and support breastfeeding goals 5.
Nutritional Surveillance and Management
- Primary care physicians play a crucial role in coordinating medical and social services, nutritional surveillance, and managing conditions associated with prematurity 6.
- Enriched formula and nutrient fortifiers may be used for infants with extrauterine growth restriction, and iron supplementation is recommended for breastfed infants 6.
- Screening for iron deficiency anemia and developmental delay is essential in preterm infants, and preventive measures such as palivizumab may be recommended to prevent complications from respiratory syncytial virus infection 6.