Yenidoğanda Hiperglisemi: Hastalarımızın Demografik ve Klinik özelliklerinin Değerlendirilmesi

Öz

Amaç: Yenidoğan bebeklerde görülen hipergliseminin sıklığı, altta yatan nedenleri, klinik seyri ve sonuçlarının araştırılması. Olgular ve Yöntem: Kasım 2008-Şubat 2010 tarihleri arasında yenidoğan yoğun bakım ünitemize herhangi bir nedenle yatan hastalar arasında plazma glukozu ≥180 mg/dl bulunan hastaların tümü (112 hasta) çalışmaya alındı. Bulgular: Olguların 52’si (%46.4) preterm, 60’ı term (%53.6) hastalardı. Hiperglisemi prevalansı genel olarak %6.9 bulunurken; bu değer term gruba (%4.95) kıyasla preterm grupta (%12.7) daha yüksek bulundu (p<0.05). Transport sırasında fazla mayi verilmesine bağlı olarak 10 preterm (10/23) ve bir term hastada (1/19) ağırlık artışı saptandı. Preterm grupta hiperglisemiye neden olan durumların başlıca respiratuvar distres sendromu (%44.2), asfiksi-asidoz (%36.5), enfeksiyon (%32.7), total parenteral beslenme (%23.1) veya ilaç tedavisi (%9.6) olduğu belirlendi. Term grupta ise altta yatan nedenlerin asfiksi-asidoz (%58.3), enfeksiyon (%26.7), kan değişimi (%25) ve periton diyalizi (%10) olduğu görüldü. İnsülin tedavisi preterm grupta dokuz (%17.3), term grupta dört hastaya (%6.7) verilmişti. Preterm hastaların 14’ünün (%26.9), term hastaların ise 20’sinin (%33.3) hiperglisemi/altta yatan hastalığa bağlı kaybedildiği görüldü. Sonuçlar: Transport sırasında fazla mayi verilmesi ve ısı düzensizlikleri yanında respiratuvar distres sendromu, asfiksi-asidoz ve enfeksiyon gibi stres durumları yenidoğan hiperglisemisine zemin hazırlayan başlıca nedenlerdir.

Anahtar Kelimeler

• Düşük doğum ağırlığı, hiperglisemi, insülin, yenidoğan, preterm bebek, sonuç

NEONATAL HYPERGLYCEMIA: EVALUATION OF THE DEMOGRAPHYCAL AND CLINICAL CHARACTERISTICS OF OUR PATIENTS

Öz

Aim: To evaluate the prevalence, underlying causes, clinical course, and outcomes of the neonatal hyperglycemia. Patient and method: Among the all patients that hospitalized in our neonatal intensive care unit (NICU) for any reason between November 2008 and February 2010, the 112 patients with a plasma glucose level of ≥180 mg/dl were enrolled into the study. Results: Of the 112 hyperglycemic patients, 52 (46.4%) were preterm and 60 (53.6%) were full-term infants. While the rate of hyperglycemia was 6.9% in all of the patients; it was found higher in preterm group (12.7%) than that of full-term group (4.95 %), (p<0.05). Weight gain was noticed in 10 preterm (10/23) and one fullterm infants (1/19) due to excess parenteral fluid administration during transport of neonates. Respiratory distress syndrome (44.2%), asphyxia-acidosis (36.5%), infection (32.7%), and use of total parenteral nutrition (23.1%) or medications (9.6%) were the main underlying causes of the hyperglycemia in preterm group. In full-term group, asphyxia-acidosis (58.3%), infection (26.7%), exchange transfusion (25%), and peritoneal dialysis (10%) were the main causes of hyperglycemia in term group. Insulin treatment was needed in 9 (17.3%) preterm and 4 (6.7%) full-term patients. Of the study patients, 14 (26.9%) preterm and 20 (33.3%) full-term infants died from hyperglycemia/underlying diseases. Conclusions: In addition to excess parenteral fluid administration and hypothermia during the transportation of neonates, stressful conditions like respiratory distress syndrome, asphyxia-acidosis, and infection are main underlying causes for neonatal hyperglycemia

Anahtar Kelimeler

• Low birth weight, hyperglycemia, insulin, newborn, preterm infant, outcome

Kaynakça

1. Thureen PJ. Early aggressive nutrition in the neonate. Pediatr Rev 1999; 20:45-55.
2. Ogilvy-Stuart AL, Beardsall K. Management of hyperglycaemia in the pre- term infant. Arch Dis Child Fetal Neonatal Ed 2010; 95:126-131.
3. Şimşek DG. Neonatal hiperglisemi. Turkiye Klinikleri j Pediatr Sci 2008; 4:130-136.
4. McGowan JE, Perlman JM. Glucose management during and after intensive delivery room resuscitation. Clin Perinatol 2006; 33:183-196.
5. Kairamkonda VR, Khashu M. Controversies in the management of hypergl- ycemia in the ELBW infant. Indian Pediatr 2008; 45:29-38.
6. Hemachandra AH, Cowett RM. Neonatal hyperglycemia. Pediatr Rev 1999; 20:16-24.
7. Kao LS, Morris BH, Lally KP, Stewart CD, Huseby V, Kennedy KA. Hyperglycemia and morbidity in mortality in extremely low birth weight infants. J of Perinatol 2006; 26:730-736.
8. Alsweiler JM, Kuschel CA, Bloomfield FH. Survey of the management of neonatal hyperglycemia in Australia. J Paediatr Child Health 2007; 43:632- 635.

9. Pati NK, Maheshwari R, Pati NK, Salhan RN. Transient neonatal hypergl- ycemia. Indian Pediatr 2001; 38:898-901.
10. Collins JW Jr, Hoppe M, Brown K, Edidin DV, Padbury J, Ogata ES. A cont- rolled trial of insulin infusion and parenteral nutrition in extremely low birth weight infants with glucose intolerance. J Pediatr 1991; 118:921-927.
11. Sinclair JC, Bottino M, Cowett RM. Interventions for prevention of neonatal hyperglycemia in very low birth weight infants. Cochrane Database Syst Rev 2009; 3:CD007615.
12. Digiacomo JE, William W, Hary JR. Abnormal glucose homeostasis. In: Sinclair JC, Bracken MB (eds). Effective Care of Newborn Infant. 1st ed. New York: Oxford University Press, 1992:591-600.
13. Pildes RS, Lilien LD. Metabolic and endocrine disorders. In: Fanaroff AA, Martin RJ (eds). Neonatal Perinatal Medicine: Disease of the Fetus and Infant. 5th ed. Chicago: Mosby, 1992:1152-1179.
14. Hume R, Burchell A, Williams FL, Koh DK. Glucose homeostasis in the newborn. Early Hum Dev 2005; 81:95-101.
15. Stonestreet BS, Rubin L, Pollak A, Cowett RM, Oh W. Renal functions of low birth weight infants with hyperglycemia and glucosuria produced by glu- cose infusions. Pediatrics 1980; 66:561-567.
16. Blanco CL, Baillargeon JG, Morrison RL, Gong AK. Hyperglycemia in ext- remely low birth weight infants in a predominantly Hispanic population and related morbidities. J Perinatol 2006; 26:737-741.
17. Şen Y, Kurt N, Doğan Y, Akarsu S, Aygün D. Yenidoğanlarda hiperglisemi sıklığı ve nedenleri. Türk Ped Arş 2008; 43:55-58.
18. Dweck HS, Cassady G. Glucose intolerance in infants of very low birth we- ight. I. Incidence of hyperglycemia in infants of birth weight 1,100 grams or less. Pediatrics 1974; 53:189-195.
19. Kalhan SC, Saker F. Metabolism of glucose in very LBW infants. In: Fanaroff AA, Martin RJ (ed). Neontatal Perinatal Medicine: Disease of the Fetus and Infant. 6th ed. Chicago: Mosby, 1997:1461-2.
20. Louik C, Mitchell AA, Epstein MF, Shapiro S. Risk factors for neonatal hyperglycemia associated with 10% dextrose infusion. Am J Dis Child 1985; 139:783-786.
21. White RH, Frayn KN, Little RA, Threlfall CJ, Stoner HB, Irving MH. Hormonal and metabolic responses to glucose infusion in sepsis studied by the hyperglycemic glucose clamp technique. JPEN J Parenter Enteral Nutr 1987; 11:345-353.
22. Halliday HL, Ehrenkranz RA. Early postnatal (<96 hours) corticosteroids for preventing chronic lung disease in preterm infants. Cochrane Database Syst Rev 2001; 1:CD001146.
23. Diderholm B, Ewald U, Gustafsson J. Effect of theophylline on glucose pro- duction and lipolysis in preterm infants (< or = 32 weeks). Pediatr Res 1999; 45:674-679.
24. Türkmen M, Ulucan H, Aydoğdu SA, Biçkici A, Inan G. Transient neona- tal diabetes mellitus: a patient report. J Pediatr Endocrinol Metab 2003; 16:1057-1059.
25. Hays SP, Smith EO, Sunehag AL. Hyperglycemia is a risk factor for early death and morbidity in extremely low birth-weight infants. Pediatrics 2006; 118:1811-1818.
26. Alexandrou G, Skiöld B, Karlén J, Tessma MK, Norman M, Aden U, Vanpee M. Early hyperglycemia is a risk factor for death and white matter reduction in preterm infants. Pediatrics 2010; 125:584-591.
27. Alaedeen DI, Walsh MC, Chwals WJ. Total parenteral nutrition-associated hyperglycemia correlates with prolonged mechanical ventilation and hospital stay in septic infants. J Pediatr Surg 2006; 41:239-244.
28. Kaufman D, Fairchild KD. Clinical microbiology of bacterial and fungal sep- sis in very-low-birth-weight infants. Clin Microbiol Rev 2004; 17:638-680.
29. Manzoni P, Castagnola E, Mostert M, Sala U, Galletto P, Gomirato G. Hyperglycaemia as a possible marker of invasive fungal infection in preterm neonates. Acta Paediatr 2006; 95:486-493.
30. Cowett RM, Oh W, Schwartz R. Persistent glucose production during gluco- se infusion in the neonate. J Clin Invest 1983; 71:467-475.
31. Lilien LD, Rosenfield RL, Baccaro MM, Pildes RS. Hyperglycemia in stres- sed small premature neonates. J Pediatr 1979; 94:454-459.
32. Meetze W, Bowsher R, Compton J, Moorehead H. Hyperglycemia in extremely-low-birth-weight infants. Biol Neonate 1998; 74:214-221.