Glucose Infusions into Peripheral Veins in Neonates with Hypoglycemia

Intravenous glucose infusions into peripheral veins are often needed, in addition to oral feedings, to elevate blood glucose levels in the management of neonatal hypoglycemia. Central venous catheters are rarely inserted, when the duration of such treatment is less than a few days. More than half of peripheral venous cannulations extravasate by 36 h, or even faster, if medication is administered concomitantly (Möller et al., 1996, Hecker et al., 1991). Complications, including local swelling and in the worst cases damage to tissue may occur. Intravenous solutions containing 10 or 15 percent glucose are most commonly used in hypoglycemic infants. A glucose concentration of 15% has generally been regarded as the highest acceptable for use in solutions infused into peripheral veins in neonates. (Kien, 1993). However, 10% and even 15% glucose infusions increase fluid load especially in patients, who need high glucose intakes to reach sufficient energy intake or to maintain normal plasma glucose levels. Although large fluid volumes of short duration are well tolerated in neonates (Leake, et al, 1976), the effect of continuous rapid infusions on the fluid clearance have not been determined. First voiding might be delayed due to elevated Arginine vasopressin levels in newborn infants delivered vaginally after a prolonged and stressful labor (Vuohelainen T et al., 2007 and 2008). A poor fluid tolerance during the first days of life can be anticipated and cautious fluid administration might be indicated especially in such infants. Earlier studies suggest that the development of phlebitis does not depend so much on the osmolarity of the solution as other factors causing phlebitis, for example material of the catheter (Madan et al., 1992). Factors affecting the development of infusion phlebitis include vein characteristics, size and material of the catheter, duration of infusion and the osmolarity and pH of the infusion solution. Experimental infusions of 10% glucose with electrolytes (pH 4.93, osmolarity 727 mOsm/kg) into rabbit ear veins cause phlebitis by reason of its acidity and an infusion of amino acids (pH 6.29, osmolarity 929 mOsm/kg) by reason of its high osmolarity. On the other hand, admixture of these solutions causes only minor phlebitic changes and the fluid components eliminate each others’ damaging effects on the tissue (Kuwahara et al., 1998a). In the same animal model, the tolerance of peripheral venous endothelial cells was for 8 h in 820 mOsm/kg, 12 h in 690 mOsm/kg and 24 h in 550 mOsm/kg solutions, respectively, suggesting that a planned volume of solutions with high osmolarity should be infused rapidly rather than slowly to avoid the development of phlebitis (Kuwahara et al. 1998b). In the management of hypoglycemia, however, only continuous