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[Practice for insulin infusion in preterm infants].
D Mitanchez-Mokhtari1, E Walter-Nicolet, C Farges
1Service de réanimation pédiatrique et néonatale, hôpital Necker-Enfants-Malades, AP-HP, 149-161, rue de Sèvres, 75743 Paris cedex 15, France. delphine.mitanchez@nck.ap-hop-paris.fr <delphine.mitanchez@nck.ap-hop-paris.fr>
Summary
Transient neonatal hyperglycemia in preterm infants is common. Continuous insulin infusion is effective, but practices vary widely across French neonatal intensive care units, impacting reliable delivery and leading to frequent hyperglycemia and insulin resistance.
Area of Science:
- Neonatal Medicine
- Endocrinology
- Pharmacology
Context:
- Transient neonatal hyperglycemia affects preterm infants (<30 weeks gestational age) within the first week of life.
- Continuous insulin infusion is a recognized treatment for this condition.
- Significant variability exists in insulin administration protocols across French neonatal intensive care units.
Purpose:
- To survey current practices for insulin administration in French neonatal intensive care units.
- To identify variations in glucose targets, insulin dosages, concentrations, and flow rates.
- To assess methods used to mitigate insulin adsorption and their effectiveness.
Summary:
- A survey of 38 French neonatal intensive care units revealed diverse insulin infusion protocols for preterm infants with hyperglycemia.
- Wide ranges in target glucose levels (7-16.5 mmol/l), initial insulin doses (0.01-0.1 U/kg/h), and concentrations (0.01-0.1 U/ml) were reported.
- Despite measures to control insulin loss, hyperglycemia (30%) and insulin resistance (47%) remained frequent issues.
Impact:
- Highlights the need for standardized insulin delivery protocols in neonatal care.
- Informs the development of a reliable insulin delivery method for preterm infants.
- Aims to improve glycemic control and reduce complications in vulnerable neonates.