The potential risks and benefits of insulin treatment in hyperglycaemic preterm neonates

Area of Science:

• Neonatal Medicine
• Endocrinology
• Pediatric Critical Care

Background:

• Preterm hyperglycaemia (high blood sugar) is frequent in infants born before 29 weeks gestation.
• It is associated with increased mortality and morbidity in vulnerable newborns.
• Treatment thresholds for hyperglycaemia vary widely, despite a consistent definition (>8 mmol/L).

Purpose of the Study:

• To review current management strategies for preterm hyperglycaemia.
• To evaluate the role of insulin therapy and glucose reduction in preterm infants.
• To assess the impact of these interventions on nutritional intake and growth outcomes.

Main Methods:

• Literature review of studies on preterm hyperglycaemia management.
• Analysis of clinical practices regarding insulin therapy and glucose reduction.
• Examination of evidence on early nutrition, amino acid administration, and blood glucose control.

Main Results:

• Insulin therapy is common but carries a risk of hypoglycemia, contrasting with international guidance.
• Early parenteral amino acids may improve blood glucose control and postnatal head growth.
• Glucose reduction strategies may compromise early nutrition but avoid potential long-term complications.

Conclusions:

• Balancing blood glucose control with optimal nutrition is critical for preterm infants.
• Further long-term neurodevelopmental studies are needed to fully assess intervention impacts.
• Careful consideration of risks and benefits is essential when managing preterm hyperglycaemia.