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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
PubMed

Insights

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.

Keywords:
HyperglycemiaInfant, Extremely Low Birth WeightPrognosis

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