Both Relative Insulin Resistance and Defective Islet β-Cell Processing of Proinsulin Are Responsible for Transient Hyperglycemia in Extremely Preterm Infants

Mitanchez-Mokhtari, D.; Lahlou, Najiba; Kieffer, François; Magny, Jean‐François; Roger, M; Voyer, M

doi:10.1542/peds.113.3.537

Cited by 151 publications

(110 citation statements)

References 22 publications

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“…This supports the existing data that suggest hepatic glucose production, pancreatic beta cell response and insulin sensitivity are physiologically related and developmentally regulated. 3,[17][18][19] Contrary to previous reports, sepsis and postnatal steroid exposure during the first 2 weeks of life were not associated with hyperglycemia, although a trend existed with postnatal steroid exposure. The lack of association with steroids may be due to the small number of euglycemic patients or to the change in clinical practice of using lower dexamethasone doses and shorter regimens.…”

Section: Discussioncontrasting

confidence: 70%

Hyperglycemia in extremely low birth weight infants in a predominantly Hispanic population and related morbidities

et al. 2006

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Objective: This study describes the incidence, correlates and subsequent morbidities of hyperglycemia, a highly prevalent condition in extremely low birth weight (ELBW) infants.Study design: A retrospective chart review of 169 infants with birth weight (BW)<1000 g was conducted. Hyperglycemia was defined as plasma glucose level X150 mg/dl during the first 2 weeks of life. Data were analyzed by logistic regression, multivariate analysis and Fisher exact test.Results: Overall, 88% of the study sample developed hyperglycemia in the first 2 weeks of life. Both gestational age (GA) (odds ratio (OR) 0.11, 95% confidence interval (CI) ¼ 0.01-0.89) and chorioamnionitis (OR 0.10, 95% CI ¼ 0.01-0.64) were inversely associated with hyperglycemia, whereas BW, sepsis and postnatal steroid exposure were not. After adjusting for GA, BW and postnatal steroids, hyperglycemia was associated with a statistically significant increase in retinopathy of prematurity (ROP) (OR 4.6, 95% CI 1.12-18.9). No association was found with bronchopulmonary dysplasia, intraventricular hemorrhage, death or prolonged hospital stay. Conclusion:Lower GA was identified as the main factor associated with hyperglycemia in ELBW infants during the first 2 weeks of life. Hyperglycemia was associated with an increased incidence of ROP; further studies need to determine if this association is causal.

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Section: Discussioncontrasting

confidence: 70%

Hyperglycemia in extremely low birth weight infants in a predominantly Hispanic population and related morbidities

et al. 2006

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“…The known mechanisms responsible for hyperglycaemia specific to extremely premature infants are related to their reduced ability to produce insulin [11]; defective beta-cell processing of pro-insulin (which is 10-16 times less active than insulin) to insulin [12]; an inability to suppress hepatic glucose production in response to glucose infusion [13]; and, finally, a decreased uptake of glucose secondary to a limited mass of insulin-sensitivity tissues (e.g. : muscle and adipose tissue) [14].…”

Section: Introductionmentioning

confidence: 99%

Development of blood glucose control for extremely premature infants

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Lynn

et al. 2011

Computer Methods and Programs in Biomedicine

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Abstract:Extremely premature neonates often experience hyperglycaemia, which has been linked to increased mortality and worsened outcomes. Insulin therapy can assist in controlling blood glucose levels and promoting needed growth. This study presents the development of a model-based stochastic targeted controller designed to adapt insulin infusion rates to match the unique and changing metabolic state and control parameters of the neonate. Long-term usage of targeted BG control requires successfully forecasting variations in neonatal metabolic state, accounting for differences in clinical practices between units, and demonstrating robustness to errors that can occur in everyday clinical usage. Simulation studies were used to evaluate controller ability to target several common BG ranges and evaluate controller sensitivity to missed BG measurements and delays in control interventions on a virtual patient cohort of 25 infants developed from retrospective data. Initial clinical pilot trials indicated model performance matched expected performance from simulations. Stochastic targeted glucose control developed using validated patient-specific virtual trials can yield effective protocols for this cohort. Long-term trials show fundamental success, however clinical interface design appears as a critical factor to ensuring good compliance and thus good control.3

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“…They have impaired glucose tolerance attributed to insufficient processing of pro-insulin by the immature pancreas, and decreased sensitivity of the liver to insulin, leading to continuous glucose production despite hyperglycemia. 1,2 The relationship between hyperglycemia and morbidity (e.g., intraventricular hemorrhage, which could be mediated by changes in osmolal concentration) 3 and mortality in this population is still not clearly defined. In this month's Journal of Perinatology, Kao et al 4 and Blanco et al 5 describe multivariate analyses of this relationship in large samples of ELBW infants from single-site centers.…”

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confidence: 99%