Overfeeding-associated hyperglycemia and injury-response homeostasis in critically ill neonates
Tina Tian1, Joshua Coons2, Hong Chang3
1Tufts University School of Medicine, 145 Harrison Avenue, Boston, MA, 02111, USA.
Insights
Critically ill neonates with severe injuries experience disrupted metabolic responses. Overfeeding, particularly in high-stress infants receiving total parenteral nutrition (TPN), exacerbates hyperglycemia.
Area of Science:
- Neonatal intensive care
- Pediatric critical care
- Metabolic stress response
Background:
- Injury severity triggers a metabolic stress response, increasing hyperglycemia risk.
- Overfeeding during high stress may worsen hyperglycemia and disrupt homeostasis.
Purpose of the Study:
- To investigate the impact of excess caloric delivery on hyperglycemia and homeostasis in acutely injured premature infants.
- To determine if overfeeding exacerbates hyperglycemia in high-stress NICU infants.
Main Methods:
- Retrospective review of 563 patient days in premature NICU infants.
- Categorization of infants into high (CRP ≥50mg/L) and low (CRP <50mg/L) stress groups based on C-reactive protein (CRP).
- Analysis of glycemic variability, caloric intake, and serum glucose levels.
Main Results:
- Higher injury severity correlated with increased glycemic variability.
- Overfeeding (≥70 kcal/kg/day) in high-stress infants led to significantly higher maximum serum glucose levels (230.33±55.81 mg/dL) compared to lower intake (<70 kcal/kg/day) (135.71±37.97 mg/dL).
- High stress group showed negative correlation between pre-albumin and CRP levels.
Conclusions:
- Increased injury severity disrupts homeostasis in critically ill neonates.
- Total parenteral nutrition (TPN)-associated overfeeding worsens hyperglycemia in severely injured infants, highlighting the need for careful caloric management.
Background:
Injury severity induces a proportionate acute metabolic stress response, associated with increased risk of hyperglycemia. We hypothesized that excess caloric delivery (overfeeding) during high stress states would increase hyperglycemia and disrupt response homeostasis.
Methods:
Gestational age, daily weight, total daily caloric intake, serum C-reactive protein (CRP), prealbumin, and blood glucose concentrations in all acutely-injured premature NICU infants requiring TPN over the past 3years were reviewed. Injury severity was based on CRP and patients were divided into high (CRP ≥50mg/L) versus low (CRP <50mg/L) stress groups. Glycemic variability was used to measure disruption of homeostasis.
Results:
Overall sample included N=563 patient days (37 patients; 42 episodes). High stress group pre-albumin levels negatively correlated with CRP levels (R=-0.62, p<0.005). A test of equal variance demonstrated significantly increased high stress glycemic variability (Ha:ratio>1, Pr(F>f)=0.0353). When high stress patients were separated into high caloric intake (≥70kg/kcal/day) versus low caloric intake (<70kg/kcal/day), maximum serum glucose levels were significantly higher with overfeeding (230.33±55.81 vs. 135.71±37.97mg/dL, p<0.004).
Conclusion:
Higher injury severity induces increased disruption of response homeostasis in critically ill neonates. TPN-associated overfeeding worsens injury-related hyperglycemia in more severely injured infants.
Type Of Study:
Retrospective study.
Level Of Evidence:
Level II.
Related Concept Videos
01:16What is Homeostasis?
01:31pH Homeostasis
Respiratory...
01:21Skeleton and Calcium Homeostasis
01:16Critical Region, Critical Values and Significance Level
In hypothesis testing, a sample statistic is converted to a test statistic using z, t, or chi-square distribution. A critical region is an area under the curve in probability distributions demarcated by the critical value. When the test statistic falls in this region, it suggests that the null hypothesis must be rejected. As this region contains all those values of the...
01:31Critical Values
01:19Critical Thinking
Colleges and universities are...