A neonate with plasma glucose around 197 mg/dL: does this hyperglycemia require adjustment of IV fluids or insulin therapy?

• A. Requires aggressive IV fluids and insulin
• B. Requires IV fluids but not insulin
• C. Requires insulin but not IV fluids
• D. Does not require adjustment of IV fluids or insulin therapy

Answer: (D)

A mild, transient rise in glucose is common in neonates and often reflects stress or immature glucose regulation rather than a need for urgent therapy. A single plasma glucose around 197 mg/dL, in a stable neonate, does not automatically require changing IV fluids or starting insulin. Insulin therapy carries the risk of inducing hypoglycemia and is typically reserved for persistent hyperglycemia (repeated high readings over several hours) or very high levels with clinical instability. In practice, you’d monitor and recheck, assess whether the infant is on dextrose-containing fluids, and reserve any adjustment or insulin for ongoing hyperglycemia or evolving symptoms.