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OAbstract Objective: To determine the prevalence of insulin treatment in premature infants with hyperglycemia and evaluate association of length of treatment with outcomes. Study Design: Cohort study of 29 974 infants 22-32 weeks gestational age (GA) admitted to over 300 NICUs (Neonatal Intensive Care Unit) from 1997-2018 and diagnosed with hyperglycemia. Results: Use of insulin significantly decreased during the study period [P=0.002] among studied NICUs. The percentage of hyperglycemic infants exposed to insulin ranged from 0 to 81%. Infants who received insulin were more likely to have lower GA, birth weight, 5-minute Apgar score, longer duration of stay, and require mechanical ventilation. After adjustment for GA, infants requiring insulin for >14 days were more likely to have treated retinopathy of prematurity (ROP) and develop chronic lung disease (CLD). Insulin treatment of 1-7 days had increased odds of death, death/ROP, and death/CLD compared to no exposure. Conclusions: Insulin use decreased over time, and differing durations of use were associated with adverse outcomes.

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