J Zeller1, M Voyer, P F Bougnères. 1. Service d'endocrinologie pédiatrique, hôpital Saint-Vincent-de-Paul, Paris, France.
Abstract
BACKGROUND: Hyperglycemia in the neonate may be permanent or more frequently transient. Its treatment is still debated. PATIENTS AND METHODS: The files of 19 infants with hyperglycemia were retrospectively analysed. Their birth-weights were more than 900 g and their gestational ages more than 27 weeks. Plasma glucose, insulin, C-peptide, islet-cell and insulin autoantibodies were measured in each patient. RESULTS: Blood glucose ranged from 1.2 to 10 g/l (mean: 5.05 +/- 1.0), between the second hour and the 60th day of life. Four infants presented with permanent neonatal diabetes mellitus: they were small for gestational age. Hyperglycemia was noted from the first day of life. C-peptide levels were less than 0.1 pmol/ml and autoantibodies were absent. Two sibs had hypothyroidism, one patient had unclassifiable chronic diarrhea plus renal disease, the fourth patient had ventricular septal defect. The 15 other patients presented with a transient hyperglycemia that appeared lately (6.1 +/- 3.4 day of life). Hyperglycemia was induced by glucose infusion in five patients, by potentially hyperglycemic drugs in five others. C-peptide levels ranged from 0.01 to 0.76 pmol/ml (mean 0.29 +/- 0.11). One patient and his mother had insulin antibodies. Another patient had congenital heart abnormalities. Hyperglycemia required insulin therapy in 17 cases (four with permanent and 13 with transient hyperglycemia). CONCLUSION: There are no clinical or biological features permitting foresee the duration of neonatal hyperglycemia. Each patient with birth-weight below 2,500 g should be given insulin when glucosemia remains above 1.3 g/l and his weight does not increase.
BACKGROUND:Hyperglycemia in the neonate may be permanent or more frequently transient. Its treatment is still debated. PATIENTS AND METHODS: The files of 19 infants with hyperglycemia were retrospectively analysed. Their birth-weights were more than 900 g and their gestational ages more than 27 weeks. Plasma glucose, insulin, C-peptide, islet-cell and insulin autoantibodies were measured in each patient. RESULTS:Blood glucose ranged from 1.2 to 10 g/l (mean: 5.05 +/- 1.0), between the second hour and the 60th day of life. Four infants presented with permanent neonatal diabetes mellitus: they were small for gestational age. Hyperglycemia was noted from the first day of life. C-peptide levels were less than 0.1 pmol/ml and autoantibodies were absent. Two sibs had hypothyroidism, one patient had unclassifiable chronic diarrhea plus renal disease, the fourth patient had ventricular septal defect. The 15 other patients presented with a transient hyperglycemia that appeared lately (6.1 +/- 3.4 day of life). Hyperglycemia was induced by glucose infusion in five patients, by potentially hyperglycemic drugs in five others. C-peptide levels ranged from 0.01 to 0.76 pmol/ml (mean 0.29 +/- 0.11). One patient and his mother had insulin antibodies. Another patient had congenital heart abnormalities. Hyperglycemia required insulin therapy in 17 cases (four with permanent and 13 with transient hyperglycemia). CONCLUSION: There are no clinical or biological features permitting foresee the duration of neonatal hyperglycemia. Each patient with birth-weight below 2,500 g should be given insulin when glucosemia remains above 1.3 g/l and his weight does not increase.