Exogenous insulin reduces proteolysis and protein synthesis in extremely low birth weight infants

Poindexter, Brenda B.; Karn, Cheryl A.; Denne, Scott C.

doi:10.1016/s0022-3476(98)70389-0

Cited by 85 publications

(46 citation statements)

References 13 publications

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“…The data presented here are consistent with those reported in previous studies 22,24 and suggest that the experimental use of insulin infusions may be performed safely and effectively in neonates. Given the absence of nutritional methods to reduce protein breakdown, insulin may ultimately have broad applicability to the metabolic support of critically ill infants.…”

Section: Discussionsupporting

confidence: 91%

“…[8][9][10]20,21 In the pediatric population, one previous study measured the effects of insulin on protein metabolism in a cohort of 4 extremely low-birth-weight neonates. 22 The investigators showed a 20% reduction in protein breakdown, although this was associated with a corresponding decrease in protein synthetic rate. The current study therefore represents the first reported use of an intravenous insulin infusion to reduce protein catabolism in a critically ill infant population.…”

Section: Discussionmentioning

confidence: 98%

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Intravenous insulin decreases protein breakdown in infants on extracorporeal membrane oxygenation

Agus

Javid

Ryan

et al. 2004

Journal of Pediatric Surgery

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 98%

Intravenous insulin decreases protein breakdown in infants on extracorporeal membrane oxygenation

Agus

Javid

Ryan

et al. 2004

Journal of Pediatric Surgery

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“…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%

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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“…Farrag, et al identified that the rate of insulin clearance was much higher in neonates compared to a group of healthy adults [46]. In this study, a value of n = 0.9 was used, compared to 0.16 in adults [33], as derived from neonatal insulin infusion studies [18,19,46,53].…”

Section: Parameter Valuesmentioning

confidence: 99%

“…It also makes the model robust to the sometimes frequent periods where no exogenous insulin is administered. This parameter was set to a population constant of 10 mU/L/min to achieve steady state basal insulin concentrations similar to reported clinical results [46,53]. It is assumed that exogenous insulin administration suppresses endogenous insulin secretion and the parameter k I broadly captures this suppression effect.…”

Section: Parameter Valuesmentioning

confidence: 99%

Modeling the glucose regulatory system in extreme preterm infants

Compte¹,

Chase²,

Russell³

et al. 2011

Computer Methods and Programs in Biomedicine

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BACKGROUNDPremature infants represent a significant proportion of the neonatal intensive care population. Blood glucose homeostasis in this group is often disturbed by immaturity of endogenous regulatory systems and the stress of their condition. Hypo-and hyperglycemia are frequently reported in very low birth weight infants, and more mature infants often experience low levels of glycemia. A model capturing the unique fundamental dynamics of the neonatal glucose regulatory system could be used to develop better blood glucose control methods.

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Exogenous insulin reduces proteolysis and protein synthesis in extremely low birth weight infants

Cited by 85 publications

References 13 publications

Intravenous insulin decreases protein breakdown in infants on extracorporeal membrane oxygenation

Intravenous insulin decreases protein breakdown in infants on extracorporeal membrane oxygenation

Development of blood glucose control for extremely premature infants

Modeling the glucose regulatory system in extreme preterm infants

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