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Glucose disturbances in very low-birthweight infants-Results from the prospective LIGHT study
Itay Zamir1, Elisabeth Stoltz Sjöström2, Johannes van den Berg1
1Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden.
Insights
Glucose disturbances (dysglycaemia) are common in very low-birthweight infants, often appearing in the first week. These patterns suggest a developmental mechanism related to postmenstrual age.
Area of Science:
- Neonatal Medicine
- Endocrinology
- Metabolic Disorders
Background:
- Glucose homeostasis disturbances (dysglycaemia) are a significant concern in very low-birthweight infants.
- Understanding these disturbances and their risk factors is crucial for neonatal care.
Purpose of the Study:
- To describe dysglycaemia in very low-birthweight infants (<1500g) during hospitalization.
- To explore risk factors associated with these glucose disturbances.
Main Methods:
- Prospective observational cohort study (LIGHT study) of 49 very low-birthweight infants.
- Collected and analyzed 3515 glucose concentration samples during the admission period.
Main Results:
- Hyperglycaemia (>10 mmol/L) and hypoglycaemia (<2.6 mmol/L) affected 63% and 55% of infants, respectively.
- Dysglycaemia onset predominantly occurred within the first postnatal week.
- Hyperglycaemia was often independent of corticosteroid, inotrope, or antimicrobial treatments.
Conclusions:
- Dysglycaemia is highly prevalent in very low-birthweight infants.
- Glucose levels show a postmenstrual age-dependent pattern, decreasing towards term.
- The primary drivers of hyperglycaemia appear independent of common neonatal interventions like sepsis treatment or specific medications.
Aim:
To describe glucose homeostasis disturbances (dysglycaemia) in very low-birthweight infants (<1500 g) during the admission period and explore associated risk factors.
Methods:
The LIGHT (very low-birthweight infants - glucose and hormonal profile over time) study was a prospective observational cohort study that included 49 very low-birthweight infants admitted to the tertiary neonatal intensive care unit in Umeå, Sweden, during 2016-2019. All glucose concentrations (n = 3515) sampled during the admission period were registered.
Results:
Hyperglycaemia >10 mmol/L and hypoglycaemia <2.6 mmol/L were registered in 63% and 55% of the infants, respectively. Onset of dysglycaemia occurred almost exclusively in the first postnatal week. Hyperglycaemia followed 15% of corticosteroid doses given; all were preceded by pre-existing hyperglycaemia. Pre-existing hyperglycaemia was found in 66.7% of hyperglycaemic infants who received inotrope treatment. Upon commencement, 72.5% of antimicrobial treatments given were neither preceded nor followed by hyperglycaemia.
Conclusion:
Dysglycaemia was common in very low-birthweight infants. Daily means of glucose concentrations seemed to follow a postmenstrual age-dependent pattern, decreasing towards term age suggesting a postmenstrual age-dependent developmental mechanism. The primary mechanism causing hyperglycaemia was independent of sepsis, and corticosteroid and inotrope treatments. No hypoglycaemia was registered during ongoing insulin treatment.
