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Hyperglycemia in extremely- low-birth-weight infants
W Meetze1, R Bowsher, J Compton
1Department of Pediatrics, East Carolina University School of Medicine, Greenville, NC 27858-4354, USA.
Insights
Hyperglycemia in extremely-low-birth-weight infants is not linked to insulin-like growth factors (IGF). Insulin infusion is a safe treatment option for these infants, maintaining caloric intake unlike glucose reduction.
Area of Science:
- Neonatalogy
- Endocrinology
- Metabolic Disorders
Background:
- Hyperglycemia is a common issue in extremely-low-birth-weight (ELBW) infants, but its causes are not fully understood.
- Insulin-like growth factors (IGF-I and IGF-II) are crucial for infant growth, and their potential role in ELBW infant hyperglycemia warrants investigation.
Purpose of the Study:
- To investigate the relationship between hyperglycemia and serum levels of IGF-I and IGF-II in ELBW infants.
- To compare the efficacy and safety of continuous insulin infusion versus glucose intake reduction for managing hyperglycemia in ELBW infants.
Main Methods:
- A cohort of 56 ELBW infants (<1,000 g) were studied.
- Infants developing hyperglycemia were randomized to receive either reduced glucose intake or continuous insulin infusion.
- Control group (n=33) maintained normal blood glucose levels. Blood samples were collected on days 3, 8, and 15, and upon hyperglycemia development.
Main Results:
- Hyperglycemic infants had lower birth weights than controls.
- No significant differences in baseline IGF-I or IGF-II levels were found between hyperglycemic and control infants.
- Insulin infusion was safe and maintained caloric intake, while glucose reduction led to prolonged caloric deprivation.
Conclusions:
- IGF-I and IGF-II are not associated with hyperglycemia in ELBW infants.
- ELBW infants with hyperglycemia do not typically present with baseline insulin deficiency and often show a normal insulin response.
- Continuous insulin infusion is a safe and effective method for managing hyperglycemia in ELBW infants, ensuring adequate nutrition.
Abstract:
The cause of hyperglycemia in extremely-low-birth-weight (ELBW) infants is not well understood. We studied infants weighing <1,000 g to investigate the relationship of hyperglycemia to blood levels of insulin-like growth factor (IGF)-I and IGF-II. We also compared two methods of treatment for hyperglycemia: continuous insulin infusion and reduction of glucose intake. Fifty-six ELBW infants were enrolled on day 2 of life. Intravenous glucose intake was increased incrementally to a maximum of 12 mg/kg/min on day 6. Infants who developed hyperglycemia were randomly assigned to receive reduced glucose intake (n = 11) or insulin infusion (n = 12). Infants whose blood sugar remained normal served as controls (n = 33). Blood was drawn on days 3, 8 and 15 in all infants, and again when they developed hyperglycemia. Nutritional intake and laboratory results for the treatment groups were compared with controls. Hyperglycemic infants had lower birth weights than controls. Hyperglycemic infants treated with glucose reduction remained <60 kcal/kg/day longer than control or insulin infusion groups (8.6 +/- 1.3 days vs. 4.1 +/- 0.2 and 5.5 +/- 0.6 days). No infants became hypoglycemic during insulin infusion. There was no difference in baseline blood levels of IGF-I or IGF-II among the groups, and these growth factors did not change in response to hyperglycemia. Hyperglycemic infants had baseline levels of insulin which were similar to normal controls, and endogenous insulin increased in response to hyperglycemia in 15 of the 23 infants who developed hyperglycemia. IGF-I and IGF-II are not related to hyperglycemia. In our population, hyperglycemic infants did not have baseline insulin deficiency and most had a normal insulin response to hyperglycemia. Insulin infusion appears safe in these infants and helped to maintain normal caloric intake, whereas glucose reduction was associated with a prolonged caloric deprivation.