Early detection of metabolic abnormalities in preterm infants impaired by disorders of blood glucose concentrations.

We recently reported (Acta Paediatr Scand 1992;8: 580-4) three preterm infants with severe respiratory distress syndrome and abnormal glucose profiles for the first 5 days of life who subsequently died in infancy; only at autopsy were they shown to have abnormal glucose-6-phosphatase activity. We have therefore studied retrospectively in a matched cohort of 109 infants the blood glucose profiles correlated with the severity of respiratory distress syndrome (expressed as the fraction of inspired oxygen, FiO2): group A, mild, FiO2 < 0.25; group B, moderate, FiO2 0.26-0.50; group C, severe, FiO2 > 0.51. All groups had a similar frequency of low blood glucose values (15% < or = 2.2 mmol/L; 29% < or = 2.6 mmol/L), but high blood glucose values and greater variability in glucose values were more common in groups B and C despite lower caloric intakes (A, 4.3%; B, 9.3%; C, 9.6% > or = 7 mmol/L). We conclude that the early blood glucose patterns in those three previously described preterm infants with abnormal hepatic glucose-6-phosphatase activity at autopsy cannot be viewed as abnormal when considered against a matched cohort of infants. Preterm infants at risk of genetic or developmental delays in blood glucose homeostasis should be reassessed after recovery from their acute illnesses.