Relationship between insulin therapy for hyperglycemia and neurodevelopmental outcome in extremely preterm infants

This study aimed to examine whether insulin treatment for hyperglycemia in extremely preterm infants was associated with an increased risk of mortality or poor neurological prognosis.

This study included extremely preterm infants admitted to the neonatal intensive care unit from January 2019 to May 2022. Hyperglycemia was defined as a blood glucose level of greater than 15 mmol/L (270 mg/dL) within the first 28 days of age. The primary outcome includes death or neurodevelopmental impairment at 18 months postmenstrual age. Neurodevelopmental impairment was defined as a Kyoto Scale of Psychological Development test score of <70 or cerebral palsy.

Among the 136 extremely preterm infants, five exhibited congenital abnormalities, and two had missing data. Hyperglycemia was observed in 68 infants, comprising 35 treated with insulin and 33 who remained untreated. In comparison to the untreated group, the insulin-treated group reported significantly lower gestational age (23.9 vs. 25.0 weeks, p < 0.05), lower birth weight (570 vs. 658 g, p < 0.05), higher maximum blood glucose levels (507 vs. 357 mg/dL, p < 0.05), and a longer hyperglycemia duration (14 vs. 6 days, p < 0.05). Hypoglycemia after insulin therapy was reported in 17% (6/35) of infants. The logistic regression analysis identified no significant association between insulin treatment for hyperglycemia and death or neurodevelopmental impairment (odds ratio, 0.40; 95% confidence interval, 0.09-1.74).

Insulin therapy administration is not associated with death or neurodevelopmental impairment at 18 months of postmenstrual age among extremely preterm infants with hyperglycemia.