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Hyperglycemia is a blood glucose concentration > 150 mg/dL (> 8.3 mmol/L).

Hyperglycemia in neonates is most often iatrogenic, caused by too-rapid IV infusions of glucose during the 1st few days of life in very low-birth-weight infants (< 1.5 kg). The other important cause is physiologic stress from surgery, hypoxia, respiratory distress syndrome, or sepsis; fungal sepsis poses a special risk. In premature infants, partially defective processing of proinsulin to insulin Some Trade Names
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and relative insulin Some Trade Names
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resistance may cause hyperglycemia. In addition, transient neonatal diabetes mellitus is a rare self-limited cause that usually occurs in small-for-gestational-age infants; corticosteroid administration may also result in transient hyperglycemia. Hyperglycemia is less common than hypoglycemia, but it is important because it increases morbidity and mortality of the underlying causes.

Symptoms and signs are those of the underlying condition; diagnosis is by serum glucose testing. Additional laboratory findings may include glycosuria and marked serum hyperosmolarity.

Treatment of iatrogenic hyperglycemia is reduction of IV dextrose concentration (eg, from 10 to 5%) or infusion rate; hyperglycemia persisting at low dextrose infusion rates (eg, 4 mg/kg/min) may indicate relative insulin Some Trade Names
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deficiency or insulin Some Trade Names
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resistance. Treatment of other causes is fast-acting insulin Some Trade Names
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. One approach is to add insulin Some Trade Names
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to an IV infusion of 10% dextrose at a uniform rate of 0.01 to 0.1 unit/kg/h, then titrate the rate until the glucose level is normalized. Another approach is to add insulin Some Trade Names
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to a separate IV of 10% D/W given simultaneously with the maintenance IV infusion so that the insulin Some Trade Names
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can be adjusted without changing the total infusion rate. Responses to insulin Some Trade Names
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are unpredictable, and it is extremely important to monitor serum glucose levels and to titrate the insulin Some Trade Names
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infusion rate carefully.

In transient neonatal diabetes mellitus, glucose levels and hydration should be carefully maintained until hyperglycemia resolves spontaneously, usually within a few weeks.

Any fluid or electrolytes lost through osmotic diuresis should be replaced.

Last full review/revision November 2005

Content last modified November 2005