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Insulin infusion with parenteral nutrition in extremely low birth weight infants with hyperglycemia
N D Binder1, P K Raschko, G I Benda
1Department of Pediatrics, Oregon Health Sciences University, Portland 97201.
Insights
Insulin infusion helps extremely low birth weight infants with hyperglycemia achieve adequate energy intake. This treatment improves glucose tolerance without negatively impacting growth outcomes.
Area of Science:
- Neonatology
- Pediatric Endocrinology
Background:
- Extremely low birth weight (ELBW) infants often experience hyperglycemia and glycosuria.
- Managing hyperglycemia in ELBW infants is crucial for meeting energy needs and promoting growth.
Purpose of the Study:
- To define clinical characteristics of ELBW infants prone to hyperglycemia.
- To evaluate the efficacy of graded insulin infusion in achieving energy intake goals in hyperglycemic ELBW infants.
Main Methods:
- Retrospective review of 76 ELBW infants (birth weight ≤1000 gm) admitted between 1983-1986.
- Comparison of infants treated with insulin infusion (n=34) versus those not treated (n=42).
- Analysis of clinical characteristics, glucose tolerance, and energy intake in both groups.
Main Results:
- Treated infants were smaller, more immature, and required longer mechanical ventilation.
- No significant differences in glucose or energy intake between groups at various time points.
- Treated infants achieved target energy intake and regained birth weight similarly to controls.
Conclusions:
- Insulin infusion improves glucose tolerance in ELBW infants with hyperglycemia.
- Insulin therapy enables hyperglycemic ELBW infants to achieve adequate energy intake comparable to non-hyperglycemic infants.
Abstract:
From Nov. 7, 1983, to Nov. 6, 1986, all infants with birth weight less than or equal to 1000 gm admitted to Oregon Health Sciences University who had persistent hyperglycemia and glycosuria were treated with graded insulin infusion while energy intake was increased to at least 100 kcal/kg/day (419 kilojoules/kg/day). The records of these infants were reviewed to define the clinical characteristics of infants likely to develop hyperglycemia and to see whether insulin administration would allow goals for energy intake to be met. There were 76 surviving infants; 34 received insulin and 42 did not. Treated infants were smaller (767 +/- 161 vs 872 +/- 98 gm; p = 0.0004), were more immature (26.8 +/- 1.4 vs 27.7 +/- 2.0 weeks; p = 0.0115), and required mechanical ventilation longer (28 +/- 19 vs 17 +/- 15 days; p = 0.0196). There were no significant differences between the groups at 3, 7, 10, or 14 days for intravenously administered glucose or for total nonprotein energy intake at 3, 7, 10, 14, 28, or 56 days. Treated infants achieved an intake of 100 kcal/kg/day (419 kilojoules/kg/day) at 15 +/- 8 vs 17 +/- 11 days and regained birth weight at 12 +/- 6 vs 13 +/- 6 days (NS). There was no difference in percent change from birth weight at 7, 14, 28, or 56 days. Treated infants had a glucose concentration of 195 +/- 60 mg/dl (10.8 +/- 3.3 mmol/L) while receiving 7.9 +/- 3.0 mg/kg/min (43 +/- 17 mumol/kg/min) of glucose at the start of insulin infusion on days 1 to 14. Insulin was given for 1 to 58 days. The initial dose was 40 to 100 mU/gm of dextrose infused (57 to 142 nmol/mol) and then gradually decreased. Less than 0.5% of blood glucose values were 25 to 40 mg/dl (1.4 to 2.2 mmol/L). We conclude that insulin infusion improves glucose tolerance in extremely low birth weight infants and allows hyperglycemic infants to achieve adequate energy intake similar to that of infants who do not become hyperglycemic.