Management of Neonatal Hyperglycemia Through Glucose Infusion Rate Adjustment in an Extremely Low Birth Weight Preterm Infant: A Case Report

Abstract

Background: Neonatal hyperglycemia is a common metabolic disturbance in preterm infants, particularly those with extremely low birth weight (ELBW). Immaturity of glucose homeostasis, critical illness, infection, and nutritional interventions may contribute to fluctuations in blood glucose levels. Appropriate glucose management is essential to prevent both hyperglycemia-related complications and inadequate nutritional intake. Case Presentation: We report the case of a female preterm infant born at 29 weeks and 4 days of gestation with a birth weight of 815 g (ELBW). The infant was admitted to the neonatal intensive care unit with severe respiratory distress and subsequently developed neonatal pneumonia and sepsis. Initial blood glucose was 44 mg/dL and increased to 128 mg/dL following a 10% dextrose bolus. Six hours after correction of the initial hypoglycemia, blood glucose increased to 201 mg/dL, indicating neonatal hyperglycemia. Glucose management was performed through serial blood glucose monitoring and individualized adjustment of the glucose infusion rate (GIR). The GIR was adjusted from 5.56 mg/kg/min on the first day to 6.94 mg/kg/min on the second day and 8.33 mg/kg/min on the third day. Blood glucose subsequently decreased to 122 mg/dL and 88 mg/dL, respectively, without insulin therapy. The infant received respiratory support, antibiotic therapy, nutritional management, and supportive care. During the subsequent hospitalization, respiratory status gradually improved. Endotracheal tube culture later confirmed ventilator-associated pneumonia caused by Serratia marcescens. Conclusion: This case highlights the dynamic nature of glucose dysregulation in an ELBW preterm infant with critical illness and infection. The transition from early hypoglycemia to hyperglycemia emphasizes the importance of serial glucose monitoring and individualized GIR adjustment. In this case, glucose levels were successfully controlled without insulin therapy, while maintaining adequate glucose delivery to support the nutritional requirements of a high-risk preterm infant. Integrated metabolic, nutritional, respiratory, and infectious monitoring is essential in the management of glucose disturbances in ELBW infants.