Can early hyperglycemia affect the morbidity/mortality of very low birth weight premature infants?
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Published on: November 20, 2015
Aleksandra Simovic1, Admir Kuc1, Ema Jevtic1
1Departments of Pediatrics, University of Kragujevac, Faculty of Medical Sciences, Serbia.
Insights
Early hyperglycemia in premature infants (gestational age ≤32 weeks) is linked to increased mortality and complications like necrotizing enterocolitis. Close glucose monitoring is crucial for very low birth weight infants to mitigate risks.
Area of Science:
- Neonatalogy
- Pediatric Endocrinology
- Critical Care Medicine
Background:
- Premature infants, particularly those with very low birth weight, are susceptible to metabolic disturbances.
- Early life glucose dysregulation, including hyperglycemia, poses significant risks to neonatal health.
- Understanding the impact of hyperglycemia is vital for improving outcomes in high-risk neonates.
Purpose of the Study:
- To investigate the association between early hyperglycemia and morbidity/mortality in very low birth weight premature infants.
- To identify specific complications linked to hyperglycemia in this vulnerable population.
- To inform clinical management strategies for glucose control in premature neonates.
Main Methods:
- Retrospective analysis of premature infants (gestational age ≤32 weeks) over a three-year period.
- Definition of hyperglycemia based on specific blood glucose thresholds within the first week of life.
- Assessment of various neonatal morbidities and mortality in relation to glycemic status.
Main Results:
- Hyperglycemia was significantly associated with lower APGAR scores, necrotizing enterocolitis, and shorter mechanical ventilation duration.
- Infants with hyperglycemia experienced significantly higher mortality rates (35.5%) compared to normoglycemic infants (4.9%).
- Hyperglycemic infants required more frequent inotropic and insulin therapy, but not associated with retinopathy of prematurity, bronchopulmonary dysplasia, or sepsis.
Conclusions:
- Early hyperglycemia is a critical factor associated with increased mortality and specific morbidities in very low birth weight premature infants.
- Close monitoring of blood glucose levels is essential for early detection and management of hyperglycemia.
- Effective glucose homeostasis management can potentially improve short-term and long-term outcomes for premature neonates.
Background:
The study aimed to examine the effect of early hyperglycemia on the morbidity/mortality of very low birth weight premature infants.
Methods:
This retrospective study included all premature infants with gestational age ≤32 gestational weeks, hospitalized at the Department of Intensive Neonatal Care, Clinical Center Kragujevac, during the period 2017-2019. Hyperglycemia was defined as glycemia of ≥12 mmol/l in one measurement, or > 10 mmol/l in two measurements, at repeated intervals of 2-4 hours. Glycemia was determined from capillary blood, using a gas analyzer of Gem Premier 3000, during the first 7 days of life. Continuous intravenous insulin infusion was administered after ineffective glucose restriction at glycemic values of > 14 mmol/l.
Results:
Patients with normoglycemia (41/72 (56.94%)) and hyperglycemia (31/72 (43.06%)) did not differ in gender, gestational age, mode of delivery and antenatal administration of steroids, while birth weight had a tendency to be lower in the hyperglycemic group (p=0.052). Hyperglycemia was significantly associated with a low APGAR score at the fifth minute (p=0.048), necrotizing enterocolitis (p=0.011), and shorter duration of mechanical ventilation (p=0.006). Hyperglycemia was associated with significantly more frequent fatal outcomes (35.5%) when compared with the normoglycemic group (4.9%). Accordingly, these patients required inotropic (r=0.036) and insulin therapy (r < 0.001) more often. Retinopathy of prematurity, bronchopulmonary dysplasia and sepsis did not correlate with hyperglycemia in our study. Intraventricular hemorrhage of the first degree was more often associated with normoglycemia in premature infants on prolonged mechanical ventilation while more severe intracranial hemorrhage was more common in the hyperglycemic group but did not result in statistical significance due to the small number of patients.
Conclusions:
Monitoring glucose levels in the blood of very low birth weight premature infants is clinically important because abnormalities in glucose homeostasis can have serious short-term and long-term consequences.
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