Renal processing of glucose in well and sick neonates

Aims-To determine the extent of renal processing of glucose in sick and wel l neonates. Methods-Glomerular filtration rate (GFR) and the renal processing of glucos e, sodium, and water were measured using prolonged inulin infusion in 47 in fants of 26-40 weeks of gestation, aged 1-13 days. Results-GFR rose by 15% after ventilatory support was withdrawn, and was un affected by clinical instability. Fractional glucose excretion was low in t he stable unventilated babies except at very high filtered loads, but rose in one unstable, unventilated baby. It was higher in ventilated babies, and remained high for at least six days after ventilation. For water and sodiu m, net differences between intake and urine excretion were not affected by ventilation, clinical stability, or glycosuria. Conclusions-A combination of a low GFR and a high fluid intake, urine flow, and urine concentrating capacity, makes neonates very unlikely to develop an osmotic diuresis due to glycosuria while they have a blood glucose below 12 mmol/l, despite assertions to the contrary.