GLUCOSE METABOLISM IN NEWBORN INFANTS WITH CONGENITAL HEART DISEASE

本子项目是利用由NIH/NCRR资助的中心赠款提供的资源的众多研究子项目之一。子项目和研究者（PI）可能已经从另一个NIH来源获得了主要资金，因此可以在其他CRISP条目中表示。列出的机构是中心的，不一定是研究者的机构。患病的新生儿，包括患有先天性心脏病的新生儿，通常在出生后的最初几天需要完全肠外营养（TPN），直到他们耐受肠内喂养的能力得到充分确立。这些婴儿，以及那些早产的婴儿，都有葡萄糖代谢紊乱和能量补充不足的风险。为了防止低血糖和提供足够的能量摄入，这些新生儿中的一些常规接受葡萄糖，其葡萄糖转换率约为正常葡萄糖转换率的两倍（6mg /kg/min）。这种方案导致高血糖的频繁发生，特别是在早产儿和生病的婴儿中)。在危重儿童和成人中，已经证明高血糖与死亡率增加有关（4-5）。在新生儿中没有相应的研究，但患病婴儿也构成高危人群。因此，在不影响能量摄入的情况下预防高血糖，将最有可能降低不良后果的风险。目前还没有关于降低葡萄糖输注速率（预防或治疗高血糖）对先天性心脏病新生儿糖代谢（葡萄糖生成、糖异生和糖原溶解）的影响的已发表数据。本研究旨在探讨不同输注速率对先天性心脏病新生儿糖、脂、蛋白代谢的影响。了解这些患病新生儿的糖代谢生理学，对于设计适当的肠外营养成分，使他们血糖正常，并为他们提供足够的能量摄入至关重要。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Sick neonates, including those with congenital heart disease, very often require Total Parenteral Nutrition (TPN) during their first several days of life until their ability to tolerate enteral feeds is well established. These infants, as well as those born prematurely, are at risk of disturbed glucose metabolism and inadequate energy supplementation. In an effort to prevent hypoglycemia and provide a sufficient energy intake, some of these neonates are routinely receiving glucose at rates about twice their normal glucose turn over rate (6 mg/kg/min). This regimen results in a frequent occurrence of hyperglycemia, particularly in premature and sick infants). It has been demonstrated in critically ill children and adults that hyperglycemia was associated with increased mortality (4-5). There are no corresponding studies in newborns, but sick infants also constitute a high risk population. Thus, preventing hyperglycemia, without compromising the energy intake, would most likely reduce their risk of an adverse outcome. There are no published data on the effects of reducing the glucose infusion rate (to prevent or treat hyperglycemia) on glucose metabolism (glucose production, gluconeogenesis and glycogenolysis) in newborns with congenital heart disease. The purpose of this project is to determine the effects of different glucose infusion rates on glucose, lipid, and protein metabolism in newborn infants with congenital heart disease. Knowledge about the physiology of glucose metabolism in these sick neonates is crucial for designing adequate composition of parenteral nutrition that renders them normoglycemic and provide them with a sufficient energy intake.