Neonatal hyperglycemia: Current evidence, risks, and management challenges in resource-limited settings

Hyperglycemia is a frequent metabolic complication in preterm and very low birth weight neonates, with an incidence ranging from 25–80% depending on gestational age and illness severity. Despite being associated with significant morbidity and mortality, including intraventricular hemorrhage, increased infection risk, and retinopathy of prematurity, neonatal hyperglycemia remains under-recognized and lacks universal diagnostic cut-offs or standardized management guidelines. A narrative mini-review of literature published between 2015 and 2024 from PubMed and WHO sources highlights that hyperglycemia in neonates is commonly linked to prematurity, stress response, sepsis, and high glucose infusion from parenteral nutrition. While insulin therapy is used in severe cases (often defined as >180–200 mg/dL), it carries the risk of hypoglycemia and requires close monitoring, which may not be feasible in low- and middle-income country (LMIC) settings. Limited availability of continuous glucose monitoring and restricted NICU resources make diagnosis and management particularly challenging. Recent evidence suggests that careful adjustment of glucose infusion rates may be safer than routine insulin infusion in many cases, especially in resource-limited units. Overall, neonatal hyperglycemia represents a clinically important but under-studied condition with significant implications for neonatal survival and long-term outcomes. Developing consensus on diagnostic thresholds, safe management strategies, and improving access to affordable glucose monitoring technologies are essential steps to reduce complications. Further research tailored to LMIC contexts is urgently needed to create practical, evidence-based guidelines that balance safety with feasibility in neonatal intensive care.

Shindy Claudya Aprianti is a general practitioner at Imanuel Hospital, Way Halim in Bandar Lampung, Indonesia, with five years of clinical experience. She has a strong interest in pediatrics and neonatology, particularly in research related to child nutrition, neonatal outcomes, and public health strategies to address stunting. She has participated in pediatric conferences and has ongoing projects focusing on nutritional biomarkers, parental roles in child feeding, and neonatal health challenges in low-resource settings. Her long-term goal is to pursue pediatric residency and contribute to advancing neonatal and child health research in Indonesia.