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Long term postnatal development of insulin secretion in early premature infants
Insights
Premature infants show a delayed development of insulin secretion in response to glucose, taking up to 18 weeks post-birth to fully mature. Full-term infants demonstrate a more robust insulin response earlier in their development.
Area of Science:
- Neonatal physiology
- Endocrinology
- Pediatric metabolism
Background:
- Insulin secretion is crucial for glucose homeostasis.
- The development of this response in premature infants is not fully understood.
- Understanding this process is vital for managing infant nutrition and metabolic health.
Purpose of the Study:
- To investigate the postnatal development of insulin secretion in response to glucose in premature and full-term infants.
- To compare the maturation of glucose-stimulated insulin secretion between these two groups.
- To determine the timeline for achieving a mature insulin response in preterm neonates.
Main Methods:
- Studied premature (26-30 weeks gestation) and full-term infants (38-42 weeks gestation).
- Measured circulating insulin levels before and 30 minutes after glucose infusion (parenteral or enteral).
- Assessed insulin response as the ratio of increase in plasma insulin to increase in blood glucose.
Main Results:
- Premature infants exhibited a small initial insulin response that gradually increased over time.
- Full-term infants showed a more significant insulin response compared to premature infants.
- The insulin response in premature infants continued to develop slowly, reaching maturity around 18 weeks postnatal.
Conclusions:
- Early premature infants have a prolonged developmental period for glucose-stimulated insulin secretion.
- Maturation of insulin secretion can take up to 18 weeks, even with established oral nutrition.
- This highlights the extended period required for metabolic adaptation in preterm neonates.
Abstract:
The postnatal development of insulin secretion was studied in a group of premature infants (26-30 weeks gestation at birth) for periods up to 110 days after birth and in a small group of full-term infants (38-42 weeks gestation) for up to 47 days after birth. Circulating insulin levels were measured before, and at 30 min after the commencement of a glucose infusion given either parenterally or enterally depending on conceptual age and the mode of nutrition of the infant. The insulin response was assessed as the ratio of the increase in plasma insulin concentration to the increase in blood glucose concentration at 30 min. There was a small insulin response to glucose on day 1 in the premature infants and this increased slowly over the remainder of the study period regardless of the route of administration of glucose or of the mode of nutrition. The full-term infants were more responsive over the seven postnatal weeks in which they were studied. It is concluded that early premature infants can take up to eighteen weeks to develop an ability to respond fully to hyperglycaemia with insulin secretion even though full oral nutrition had been established over the last twelve weeks.