Continuous Insulin Infusion in Hyperglycemic, Very Low Birth Weight Infants

Vaucher, Yvonne E.; Walson, Philip D.; Morrow, Grant

doi:10.1097/00005176-198201020-00010

Cited by 57 publications

(22 citation statements)

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“…A small number of prospective trials have used insulin infusions to treat hyperglycaemia and/or promote growth [16,[24][25][26][27][28][29][30][31][32]. All reported insulin infusion trials have used either protocols that fixed insulin dosing to weight or other factors [25], or clinician judgment to determine insulin infusion rates.…”

Section: Introductionmentioning

confidence: 99%

“…All reported insulin infusion trials have used either protocols that fixed insulin dosing to weight or other factors [25], or clinician judgment to determine insulin infusion rates. Positive outcomes of insulin infusion have been reduced proteolysis [10,33,34], improved glucose tolerance, improved caloric intake and weight gain [16,24,[26][27][28][29]31]. Negative reports of hyperinsulinaemia include hypoglycaemia and possible metabolic acidosis due to excessive carbohydrate oxidation [34,35].…”

Section: Introductionmentioning

confidence: 99%

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Development of blood glucose control for extremely premature infants

Compte

Chase

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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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Development of blood glucose control for extremely premature infants

Compte

Chase

Lynn

et al. 2011

Computer Methods and Programs in Biomedicine

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“…Definitions have included but are not limited to blood glucose associated with X0.5% glycosuria, 3 >9.9 mmol/l (178 mg/dl) with glycosuria, 9 >8 mmol/l (144 mg/dl), 5 a single blood sugar >13.3 mmol/l (239 mg/dl) or repeated blood sugars >8.8 mmol/l (158 mg/dl) for at least 4 h, 10 and two consecutive blood sugars >12 mmol/l (>216 mg/dl) for at least 4 h. 11 The incidence of hyperglycemia in VLBW and ELBW infants also varies based on the definition used and ranges from 40 to 80%. 12,13 Although continuous insulin infusion has been utilized safely for managing hyperglycemia in ELBW infants, 4,10,11,14 the optimal glucose target has not yet been determined. Further information from observational studies regarding the association between hyperglycemia and outcome in ELBW infants is necessary before proceeding to a potential trial of conventional versus more aggressive glucose control in these infants.…”

Section: Introductionmentioning

confidence: 99%

Hyperglycemia and morbidity and mortality in extremely low birth weight infants

Kao

Morris²,

Lally³

et al. 2006

J Perinatol

171

112

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Objective: The purpose of this study was to determine the association between hyperglycemia and mortality and late-onset infections (>72 h) in extremely low birth weight (ELBW) infants.Study design: Retrospective analysis of a prospective cohort study of 201 ELBW infants who survived greater than 3 days after birth. Mean morning glucose levels were categorized as normoglycemia (<120 mg/dl), mildmoderate hyperglycemia (120 to 179 mg/dl) and severe hyperglycemia (X180 mg/dl). Hyperglycemia was further divided into early (first 3 days of age) and persistent (first week of age). Logistic regression was performed to assess whether hyperglycemia was associated with either mortality or late-onset culture-proven infection, measured after 3 and 7 days of age.Results: Adjusting for age, the odds ratio (OR) for either dying or developing a late infection was 5.07 (95% confidence interval (CI): 1.06 to 24.3) for infants with early severe hyperglycemia and 6.26 (95% CI: 0.73 to 54.0) for infants with persistent severe hyperglycemia. Adjusting for age, both severe early and persistent hyperglycemia were associated with increased mortality. Among survivors, there was no significant association between hyperglycemia and length of mechanical ventilation or length of hospital stay. Persistent severe hyperglycemia was associated with the development of Stage II/III necrotizing enterocolitis, after adjusting for age and male gender (OR: 9.49, 95% CI: 1.52 to 59.3). Conclusion:Severe hyperglycemia in the first few days after birth is associated with increased odds of death and sepsis in ELBW infants.

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“…There has been extensive clinical experience with insulin infusion in ELBW infants [3][4][5], but very limited randomized trials [6].…”

Section: Introductionmentioning

confidence: 99%

Hyperglycemia in Extremely- Low-Birth-Weight Infants

Meetze

Bowsher²,

Compton³

et al. 1998

Neonatology

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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.

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Continuous Insulin Infusion in Hyperglycemic, Very Low Birth Weight Infants

Cited by 57 publications

References 0 publications

Development of blood glucose control for extremely premature infants

Development of blood glucose control for extremely premature infants

Hyperglycemia and morbidity and mortality in extremely low birth weight infants

Hyperglycemia in Extremely- Low-Birth-Weight Infants

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