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Early insulin therapy in very-low-birth-weight infants

Kathryn Beardsall1, Sophie Vanhaesebrouck, Amanda L Ogilvy-Stuart

  • 1University of Cambridge, Cambridge, United Kingdom.

The New England Journal of Medicine
|October 31, 2008
PubMed

Insights

Early insulin therapy in very-low-birth-weight infants reduces hyperglycemia but offers little clinical benefit and may increase hypoglycemia. The study was stopped early due to futility and potential harm.

Area of Science:

  • Neonatal intensive care
  • Endocrinology
  • Pediatric critical care

Background:

  • Hyperglycemia in very-low-birth-weight infants is linked to increased morbidity and mortality.
  • Insulin therapy and glucose control are known to influence survival in adult and pediatric intensive care units.

Purpose of the Study:

  • To determine if early insulin replacement in neonates could reduce hyperglycemia.
  • To assess the impact of early insulin therapy on outcomes in very-low-birth-weight infants.

Main Methods:

  • A multicenter randomized trial assigned 195 infants to early insulin infusion and 194 to standard care.
  • Continuous glucose monitoring assessed glucose control efficacy.
  • The study was discontinued early due to concerns about futility and potential harm.

Main Results:

  • Early insulin therapy lowered mean glucose levels and reduced hyperglycemia duration.
  • Infants receiving early insulin had increased carbohydrate intake and less weight loss.
  • However, the early-insulin group experienced significantly more hypoglycemia, particularly in infants over 1 kg birth weight. Mortality at 28 days was higher in the early-insulin group.

Conclusions:

  • Early insulin therapy provides minimal clinical benefit for very-low-birth-weight infants.
  • While effective in reducing hyperglycemia, it carries an increased risk of hypoglycemia and potentially higher mortality.
Abstract

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