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Relationships between Early Nutrition, Illness, and Later Outcomes among Infants Born Preterm with Hyperglycemia

Juan David Gonzalez Villamizar1, Jacob L Haapala2, Johannah M Scheurer1

  • 1Department of Pediatrics, Division of Neonatology, School of Medicine, University of Minnesota, Minneapolis, MN.

The Journal of Pediatrics
|June 14, 2020
PubMed

Insights

Prolonged hyperglycemia in preterm infants is linked to reduced lean mass and poorer neurodevelopment. Early nutrition may mediate these effects, highlighting the importance of nutritional support in managing hyperglycemia.

Area of Science:

  • Neonatology
  • Pediatric Endocrinology
  • Developmental Pediatrics

Background:

  • Hyperglycemia is a common metabolic disturbance in preterm infants.
  • Its long-term effects on body composition and neurodevelopment are not fully understood.
  • The influence of early nutrition and illness severity on these outcomes requires further investigation.

Purpose of the Study:

  • To assess the impact of hyperglycemia on body composition and neurodevelopment in preterm infants.
  • To examine how early nutrition and illness modify these associations.
  • To identify potential mediating factors in the relationship between hyperglycemia and adverse outcomes.

Main Methods:

  • Prospective cohort study of 97 infants born before 32 weeks gestational age.
  • Data collected on hyperglycemia duration, nutrient intake, body composition (at discharge and 4 months postmenstrual age), and neurodevelopment (Bayley Scales of Infant Development III at 12 months).
  • Linear regression analyses were performed, adjusting for gestational age and accounting for early nutrition and illness severity.

Main Results:

  • Infants with hyperglycemia for ≥5 days showed reduced fat mass and fat-free mass z-scores at discharge and 4 months postmenstrual age.
  • Prolonged hyperglycemia was associated with lower cognition, language, and motor scores at 12 months.
  • These associations were attenuated by first-week nutrition but not by illness severity.

Conclusions:

  • In preterm infants (<32 weeks), ≥5 days of hyperglycemia is associated with decreased lean mass and poorer neurodevelopmental outcomes.
  • Decreased first-week nutrition may mediate these effects, possibly due to glucose infusion rate management.
  • Optimizing early nutrition is crucial for mitigating the adverse effects of hyperglycemia in this vulnerable population.
Abstract

Keywords:
body compositioninfantneurodevelopmentprematurity

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