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Outcomes of very preterm infants with hyperglycaemia treated with insulin: A systematic review and meta-analysis

Nital Patidar1, Chandra Prakash Rath2,3, Shripada Rao3,4

  • 1Paediatrics, Armadale General Hospital, Armadale, Western Australia, 6112, Australia.

Acta Paediatrica (Oslo, Norway : 1992)
|March 10, 2023
PubMed

Insights

Insulin therapy for hyperglycaemia in very preterm infants shows no clear benefits. Evidence suggests it may not improve outcomes and could potentially increase mortality and morbidities like NEC and ROP.

Area of Science:

  • Neonatal Medicine
  • Pediatric Endocrinology
  • Clinical Research

Background:

  • Hyperglycaemia is a common metabolic disturbance in very preterm infants.
  • Insulin therapy is used to manage hyperglycaemia, but its impact on infant outcomes requires clarification.

Approach:

  • Systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies.
  • Searched multiple databases (PubMed, Medline, EMBASE, Cochrane Library, EMCARE, MedNar) up to May 2022.
  • Pooled data using random-effects models for adjusted and unadjusted odds ratios.

Key Points:

  • Sixteen studies involving 5482 infants were analyzed.
  • Unadjusted analyses indicated potential associations between insulin and increased mortality, severe retinopathy of prematurity (ROP), and necrotizing enterocolitis (NEC).
  • Adjusted analyses and the single RCT did not reveal significant associations with adverse outcomes, though one RCT noted improved weight gain.

Conclusions:

  • The certainty of evidence is low to very low.
  • Current evidence suggests insulin therapy may not improve outcomes for very preterm infants with hyperglycaemia.
  • Further high-quality research is needed to definitively assess the risks and benefits of insulin treatment in this population.
Abstract

Keywords:
hyperglycaemiainsulinvery preterm infants

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