Assessment of the Relationship between Hyperglycemia during the First 24 Hours Post-surgery and the Type of Calorie Intake in the Neonatal Intensive Care Unit

Document Type: Original Article


1 Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

2 Pediatric intensive care specialist, Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

3 Département of Biology, Faculty of Sciences, Young Researchers and Elite Club, Islamic Azad University-Mashhad Branch, Mashhad, Iran

4 Neonatal Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran


Background: The present study aimed to determine the mean blood glucose during the first 24 h post-surgery and its relation with the source of calorie intake.
Methods: The data of the current observational retrospective study was collected from hospital medical records. A total of 45 neonates suffering from atresia in different parts of the gastrointestinal tract, who were candidates for open abdominal surgery from September to October 2016 were selected. Blood glucose within 24 h after the surgery were taken four times using a glucometer. Moreover, the mean blood glucose during this period was calculated. Independent Student's t-test, chi-square test, and logistic regression model were performed to assess the association of post-operative blood glucose with calorie and macronutrient intakes.
Results: In one third of neonates, the mean blood glucose of the samples during the first day after the surgery was ≥180 mg/dl and the rest of them had mean blood glucose of 40-179 mg/dl. There was a significant relationship between blood glucose BG≥180 mg/dl and calorie (P=0.001), macronutrient (carbohydrate (P<0.001), and fat (P=0.04)) intakes. After adjustment of confounding variables, carbohydrate intake was found as an independent factor in increasing BG≥180 mg/dl during the first 24 h after the surgery (P=0.01). In addition, fat intake was observed as an effective factor in decreasing BG≥180 mg/dl during this time (P=0.04).
Conclusion: The present study revealed that there was a significant relationship between mean blood glucose during the first 24 h after the surgery and intake of macronutrients (carbohydrate and fat).


1. McCowen KC, Malhotra A, Bistrian BR. Stress-induced hyperglycemia. Crit Care Clin. 2001; 17(1):107-24.
2. 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(12):730-6.
3. van der Griend BF, Lister NA, McKenzie IM, Martin N, Ragg PG, Sheppard SJ, et al. Postoperative mortality in children after 101,885 anesthetics at a tertiary pediatric hospital. Anesth Analg. 2011; 112(6):1440-7.
4. Catre D, Lopes MF, Madrigal A, Oliveiros B, Viana JS, Cabrita AS. Early mortality after neonatal surgery: analysis of risk factors in an optimized health care system for the surgical newborn. Rev Bras Epidemiol. 2013; 16:943-52.
5. Hays SP, Smith EB, Sunehag AL. Hyperglycemia is a risk factor for early death and morbidity in extremely low birth-weight infants. Pediatrics. 2006; 118(5):1811-8.
6. Klein GW, Hojsak JM, Schmeidler J, Rapaport R. Hyperglycemia and outcome in the pediatric intensive care unit. J Pediatr. 2008; 153(3):379-84.
7. Hall NJ, Peters M, Eaton S, Pierro A. Hyperglycemia is associated with increased morbidity and mortality rates in neonates with necrotizing enterocolitis. J Pediatr Surg. 2004; 39(6):898-901.
8. Gillis C, Carli F. Promoting perioperative metabolic and nutritional care. Anesthesiology. 2015; 123(6): 1455-72.
9. Adler A. Prediction of feeding difficulties in post-operative neonates. Connecticut: Yale University School of Medicine; 2014.
10. Koletzko B, Goulet O, Hunt J, Krohn K, Shamir R, Parenteral Nutrition Guidelines Working Group. 1. Guidelines on paediatric parenteral nutrition of the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and the European Society for Clinical Nutrition and Metabolism (ESPEN), supported by the European Society of Paediatric Research (ESPR). J Pediatr Gastroenterol Nutr. 2005; 41:S1-4.
11. Letton RW, Chwals WJ, Jamie A, Charles B. Early postoperative alterations in infant energy use increase the risk of overfeeding. J Pediatr Surg. 1995; 30(7):988-93.
12. Thureen PJ. Neonatal nutrition and metabolism. Cambridge: Cambridge University Press; 2012.
13. Rennie JM, Kendall G. A manual of neonatal intensive care. 15th ed. Florida: CRC Press; 2013.
14. Adler A. Prediction of feeding difficulties in post-operative neonates. Connecticut: Yale University School of Medicine; 2014.
15. Pierro A. Metabolism and nutritional support in the surgical neonate. J Pediatr Surg. 2002; 37(6):811-22.
16. Pierro A, Carnielli V, Filler RM, Smith J, Heim T. Metabolism of intravenous fat emulsion in the surgical newborn. J Pediatr Surg. 1989; 24(1):95-102.
17. Herman R, Btaiche I, Teitelbaum DH. Nutrition support in the pediatric surgical patient. Surg Clin. 2011; 91(3):511-41.
18. Bajwa SJ, Baruah MP, Kalra S, Kapoor MC.

Interdisciplinary position statement on management of hyperglycemia in peri-operative and intensive care. J Anaesthesiol Clin Pharmacol. 2015; 31(2):155.
19. Wu Y, Lai W, Pei J, Zhao Y, Wang Q, Xiang B. Hyperglycemia and its association with clinical outcomes in postsurgical neonates and small infants in the intensive care unit. J Pediatr Surg. 2016; 51(7):1142-5.
20. Lohman TG, Roche AF, Martorell R. Anthropometric standardization reference manual. Champaign, IL: Human Kinetics Books; 1988.
21. Nuntnarumit P, Chittamma A, Pongmee P, Tangnoo A, Goonthon S. Clinical performance of the new glucometer in the nursery and neonatal intensive care unit. Pediatr Int. 2011; 53(2):218-23.
22. Khajavi L, Khademi G, Mehramiz M, Norouzy A, Safarian M. Association of dysglycemia with mortality in children receiving parenteral nutrition in pediatric intensive care unit. Turkish J Pediatr. 2018; 60(2):134-41.
23. Bajwa SS, Baruah MP, Kalra S, Kapoor MC. Guidelines on Inpatient Management of Hyperglycemia. Med Update. 2010; 23:164-9.
24. Van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, et al. Intensive insulin therapy in critically ill patients. New Engl J Med. 2001; 345(19):1359-67.
25. Wu Y, Pei J, Yang XD, Zhao YY, Xiang B. Hyperglycemia and its association with clinical outcomes for patients in the pediatric intensive care unit after abdominal surgery. J Pediatr Surg. 2013; 48(4):801-5.
26. Hawdon JM, Aynsley-Green A. Disorders of blood glucose homeostasis in the neonate. London: Churchill Livingstone; 1992. P. 777-96.
27. Hemachandra AH, Cowett RM. Neonatal
hyperglycemia. New York: Pediatrics Review American Academy of Pediatrics; 1999. P. 16.
28. Srinivasa G, Jain R, Pildes RS, Kannan CR. Glucose homeostasis during anesthesia and surgery in infants. J Pediatr Surg. 1986; 21(8):718-21.
29. Anand KJ, Brown MJ, Bloom SR, Aynsley-Green A. Studies on the hormonal regulation of fuel metabolism in the human newborn infant undergoing anaesthesia and surgery. Hormone Res Paediatr. 1985; 22(1-2):115-28.
30. Jaksic T, Shew SB, Keshen TH, Dzakovic A, Jahoor F. Do critically ill surgical neonates have increased energy expenditure? J Pediatr Surg. 2001; 36(1):63-7.
31. Mehta NM, Bechard LJ, Dolan M, Ariagno K, Jiang H, Duggan C. Energy imbalance and the risk of overfeeding in critically ill children. Pediatr Crit Care Med. 2011; 12(4):398.
32. Jones MO, Pierro A, Hammond P, Nunn A, Lloyd DA. Glucose utilization in the surgical newborn infant receiving total parenteral nutrition. J Pediatr Surg. 1993; 28(9):1121-5.
33. Pierro A, Eaton S. Metabolism and nutrition in the surgical neonate. Semin Pediatr Surg. 2008; 17(4): 276-84.
34. Das JB, Joshi ID, Philippart AI. Depression of glucose utilization by Intralipid in the post-traumatic period: An experimental study. J Pediatr Surg. 1980; 15(6):739-45.
35. Ainsworth S, McGuire W. Percutaneous central venous catheters versus peripheral cannulae for delivery of parenteral nutrition in neonates. Cochrane Database Syst Rev. 2015; 10:CD004219.
36. Khan AI, Vasquez Y, Gray J, Wians Jr FH, Kroll MH. The variability of results between point-of-care testing glucose meters and the central laboratory analyzer. Arch Pathol Lab Med. 2006; 130(10): 1527-32.