Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Does hyperglycemia in hypernatremic preterm infants increase the risk of intraventricular hemorrhage?

Journal of Perinatology volume 36, pages 729–732 (2016)Cite this article

Subjects

Abstract

Objective:

Hypernatremia and hyperglycemia are highly prevalent in preterm infants during the first week after birth, and both can lead to hyperosmolarity and osmotic shifts. The objective is to determine whether hyperglycemia increases the risk of intraventricular hemorrhage (IVH) in hypernatremic preterm infants.

Study Design:

Single-center retrospective medical record review of 216 infants <1000 g birth weight and <29 weeks gestational age (admitted over a 9-year period) who had serum sodium levels and blood glucose levels monitored at least every 24 h and more frequently if indicated during the first 10 days after birth. Hyperglycemia was defined as persistently high blood glucose (usually >200 mg dl−1) treated with an insulin infusion. Hypernatremia was defined as a serum sodium level of ⩾150 mmol l−1 on repeated measurements.

Results:

Of the 216 infants studied, 76 (35%) developed hyperglycemia and 126 (58%) developed hypernatremia. IVH developed more frequently in infants with hyperglycemia (P=0.006, odds ratio (OR) 2.3, 95% confidence interval (CI) 1.3 to 4.1), in infants with hypernatremia (P=0.018, OR 2.0, 95% CI 1.2 to 3.5) and in infants with hypernatremia plus hyperglycemia (P=0.001, OR 3.2, 95% CI 1.6 to 6.4). Multivariate regression analysis confirmed the independent association of higher risk of IVH with the presence of hypernatremia plus hyperglycemia (P=0.015, OR 2.6, 95% CI 1.2 to 5.5) but not with hypernatremia or hyperglycemia alone.

Conclusion:

Hyperglycemia increases the risk of IVH in hypernatremic preterm infants.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Sheth RD . Trends in incidence and severity of intraventricular hemorrhage. J Child Neurol 1998; 13: 261–264.

    Article  CAS  Google Scholar 

  2. Wilson-Costello D, Friedman H, Minich N, Fanaroff AA, Hack M . Improved survival rates with increased neurodevelopmental disability for extremely low birth weight infants in the 1990 s. Pediatrics 2005; 115: 997–1003.

    Article  Google Scholar 

  3. Harkavy KL, Scanlon JW . Hypernatremia in the very low birthweight infant. Int J Pediatr Nephrol 1983; 4: 75–78.

    CAS  PubMed  Google Scholar 

  4. Gawlowski Z, Aladangady N, Coen PG . Hypernatraemia in preterm infants born at less than 27 weeks gestation. J Paediatr Child Health 2006; 42: 771–774.

    Article  Google Scholar 

  5. Kao LS, Morris BH, Lally KP, Stewart CD, Huseby V, Kennedy KA . Hyperglycemia and morbidity and mortality in extremely low birth weight infants. J Perinatol 2006; 26: 730–736.

    Article  CAS  Google Scholar 

  6. 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.

    Article  Google Scholar 

  7. Beardsall K, Vanhaesebrouck S, Ogilvy-Stuart AL, Vanhole C, Palmer CR, Ong K et al. Prevalence and determinants of hyperglycemia in very low birth weight infants: cohort analyses of the NIRTURE study. J Pediatr 2010; 157 (715-719): e711–e713.

    Google Scholar 

  8. Geheb MA . Clinical approach to the hyperosmolar patient. Crit Care Clin 1987; 3: 797–815.

    Article  CAS  Google Scholar 

  9. McManus ML, Churchwell KB, Strange K . Regulation of cell volume in health and disease. N Eng J Med 1995; 333: 1260–1266.

    Article  CAS  Google Scholar 

  10. Finberg L . Dangers to infants caused by changes in osmolal concentration. Pediatrics 1967; 40: 1031–1034.

    CAS  PubMed  Google Scholar 

  11. Ogata ES . Carbohydrate metabolism in the fetus and neonate and altered neonatal glucoregulation. Pediatr Clin North Am 1986; 33: 25–45.

    Article  CAS  Google Scholar 

  12. Barnette AR, Myers BJ, Berg CS, Inder TE . Sodium intake and intraventricular hemorrhage in the preterm infant. Ann Neurol 2010; 67: 817–823.

    CAS  PubMed  Google Scholar 

  13. Lim WH, Lien R, Chiang MC, Fu RH, Lin JJ, Chu SM et al. Hypernatremia and grade III/IV intraventricular hemorrhage among extremely low birth weight infants. J Perinatol 2011; 31: 193–198.

    Article  CAS  Google Scholar 

  14. Dalton J, Dechert RE, Sarkar S . Assessment of association between rapid fluctuations in serum sodium and intraventricular hemorrhage in hypernatremic preterm infants. Am J Perinatol 2015; 32: 795–802.

    Article  Google Scholar 

  15. Auerbach A, Eventov-Friedman S, Arad I, Peleg O, Bdolah-Abram T, Bar-Oz B et al. Long duration of hyperglycemia in the first 96 hours of life is associated with severe intraventricular hemorrhage in preterm infants. J Pediatr 2013; 163: 388–393.

    Article  CAS  Google Scholar 

  16. Alsweiler JM, Harding JE, Bloomfield FH . Tight glycemic control with insulin in hyperglycemic preterm babies: a randomized controlled trial. Pediatrics 2012; 129: 639–647.

    Article  Google Scholar 

  17. Volpe JJ . Brain injury in the premature infant: overview of clinical aspects, neuropathology, and pathogenesis. Semin Pediatr Neurol 1998; 5: 135–151.

    Article  CAS  Google Scholar 

  18. Linder N, Haskin O, Levit O, Klinger G, Prince T, Naor N et al. Risk factors for intraventricular hemorrhage in very low birth weight premature infants: a retrospective case-control study. Pediatrics 2003; 111: e590–e595.

    Article  Google Scholar 

  19. Fabres J, Carlo WA, Phillips V, Howard G, Ambalavanan N . Both extremes of arterial carbon dioxide pressure and the magnitude of fluctuations in arterial carbon dioxide pressure are associated with severe intraventricular hemorrhage in preterm infants. Pediatrics 2007; 119: 299–305.

    Article  Google Scholar 

  20. Kaiser JR, Gauss CH, Pont MM, Williams DK . Hypercapnia during the first 3 days of life is associated with severe intraventricular hemorrhage in very low birth weight infants. J Perinatol 2006; 26: 279–285.

    Article  CAS  Google Scholar 

  21. van der Lugt NM, Smits-Wintjens VE, van Zwieten PH, Walther FJ . Short and long term outcome of neonatal hyperglycemia in very preterm infants: a retrospective follow-up study. BMC Pediatr 2010; 10: 52.

    Article  Google Scholar 

  22. Yoo HS, Ahn SY, Lee MS, Han YM, Sung SI, Chang YS et al. Permissive hyperglycemia in extremely low birth weight infants. J Korean Med Sci 2013; 28: 450–460.

    Article  Google Scholar 

  23. Papile LA, Burstein J, Burstein R, Koffler H . Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr 1978; 92: 529–534.

    Article  CAS  Google Scholar 

  24. McCrea HJ, Ment LR . The diagnosis, management, and postnatal prevention of intraventricular hemorrhage in the preterm neonate. Clin Perinatol 2008; 35: 777–792.

    Article  Google Scholar 

  25. Shaffer SG, Meade VM . Sodium balance and extracellular volume regulation in very low birth weight infants. J Pediatr 1989; 115: 285–290.

    Article  CAS  Google Scholar 

  26. Gallini F, Maggio L, Romagnoli C, Marrocco G, Tortorolo G . Progression of renal function in preterm neonates with gestational age&lt;or=32 weeks. Pediatr nephrol 2000; 15: 119–124.

    Article  CAS  Google Scholar 

  27. Hammarlund K, Sedin G, Stromberg B . Transepidermal water loss in newborn infants. VIII. Relation to gestational age and post-natal age in appropriate and small for gestational age infants. Acta Paediatr Scand 1983; 72: 721–728.

    Article  CAS  Google Scholar 

  28. Mitanchez-Mokhtari D, Lahlou N, Kieffer F, Magny JF, Roger M, Voyer M . Both relative insulin resistance and defective islet beta-cell processing of proinsulin are responsible for transient hyperglycemia in extremely preterm infants. Pediatrics 2004; 113: 537–541.

    Article  Google Scholar 

  29. Meetze W, Bowsher R, Compton J, Moorehead H . Hyperglycemia in extremely- low-birth-weight infants. Biol Neonate 1998; 74: 214–221.

    Article  CAS  Google Scholar 

  30. Moritz ML, Ayus JC . Disorders of water metabolism in children: hyponatremia and hypernatremia. Pediatr Rev 2002; 23: 371–380.

    Article  Google Scholar 

  31. Adrogue HJ, Madias NE . Hypernatremia. N Engl J Med 2000; 342: 1493–1499.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Neonatal-Perinatal Medicine, C.S. Mott Children’s Hospital, University of Michigan Health System, Ann Arbor, MI, USA

    J Bermick, R E Dechert & S Sarkar

Authors
  1. J Bermick
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R E Dechert
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S Sarkar
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to S Sarkar.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Additional information

Disclaimer

The study is original research, has not been previously published and has not been submitted for publication elsewhere while under consideration.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bermick, J., Dechert, R. & Sarkar, S. Does hyperglycemia in hypernatremic preterm infants increase the risk of intraventricular hemorrhage?. J Perinatol 36, 729–732 (2016). https://doi.org/10.1038/jp.2016.86

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jp.2016.86

This article is cited by

Search

Advanced search

Quick links