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Permissive hyperglycemia in extremely low birth weight infants
Hye Soo Yoo1, So Yoon Ahn, Myung Sook Lee
1Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Journal of Korean Medical Science
|March 15, 2013
Summary
Permissive hyperglycemia up to 299 mg/dL in extremely-low-birth-weight infants (ELBWIs) is safe. This management strategy did not increase mortality or morbidities and showed faster weight gain in ELBWIs.
Area of Science:
- Neonatalogy
- Pediatric Endocrinology
Background:
- Extremely-low-birth-weight infants (ELBWIs) often experience glucose metabolism challenges.
- Managing hyperglycemia in ELBWIs requires careful consideration of potential risks and benefits.
Purpose of the Study:
- To evaluate the clinical outcomes of permissive hyperglycemia (blood glucose < 300 mg/dL) in ELBWIs.
- To determine if this management approach is associated with adverse effects like osmotic diuresis, increased mortality, or morbidities.
Main Methods:
- Retrospective review of 260 ELBWIs' medical records (2004-2008).
- Infants were grouped based on peak blood glucose levels and insulin treatment in the first 14 days: normoglycemia (N: ≤ 200 mg/dL), permissive hyperglycemia (P: 201-299 mg/dL without insulin), and treated hyperglycemia (T: ≥ 300 mg/dL with insulin).
Main Results:
- 46% of infants were in the treated hyperglycemia group (T), 39% in permissive hyperglycemia (P), and 15% in normoglycemia (N).
- Group P infants had lower birth weight but similar daily calorie/glucose intake and urine output compared to Group N.
- No significant correlation was found between blood glucose levels and urine output on day 7.
- Group P demonstrated faster weight gain with similar mortality, morbidities, and long-term neurological outcomes compared to Group N.
Conclusions:
- Permissive hyperglycemia up to < 300 mg/dL without insulin is not linked to osmotic diuresis in ELBWIs.
- This management strategy is not detrimental and is not associated with increased mortality or morbidities in ELBWIs.
- Permissive hyperglycemia may be a safe approach for glucose management in extremely-low-birth-weight infants.
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