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

Blanco, Cynthia L.; Baillargeon, J. G.; Morrison, Rachael; Gong, Alice

doi:10.1038/sj.jp.7211594

Cited by 125 publications

(123 citation statements)

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“…Kao et al 4 found no significant association of hyperglycemia with total number of days of mechanical ventilation among survivors and length of stay for survivors not transferred to another facility. Blanco et al 5 after adjusting for gestational age, birth weight, postnatal steroids and sepsis, showed an inverse association between hyperglycemia and chorioamnionitis (OR 0.10, 95% CI 0.01 -0.64). Blanco et al 5 also found an association between hyperglycemia and ROP (OR 4.6, 95% CI 1.1-8.9).…”

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confidence: 99%

“…Blanco et al 5 after adjusting for gestational age, birth weight, postnatal steroids and sepsis, showed an inverse association between hyperglycemia and chorioamnionitis (OR 0.10, 95% CI 0.01 -0.64). Blanco et al 5 also found an association between hyperglycemia and ROP (OR 4.6, 95% CI 1.1-8.9). There was no association between hyperglycemia and birth weight, sepsis, death, prolonged hospital stay, bronchopulmonary dysplasia, intraventricular hemorrhage or postnatal steroid exposure.…”

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confidence: 99%

“…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%

“…15 Both studies in this issue of Journal of Perinatology 4,5 found a strong association between hyperglycemia and low gestational age, whereas the association between hyperglycemia and low birth weight was either less strong 4 or not significant. 5 Kao et al 4 found a significant association between their primary outcome variable, that is, a composite outcome of either mortality or late-onset culture-proven infection (odds ratio (OR) 5.07, 95% confidence interval (CI) 1.06 to 24.3) and early (the first 3 days) severe hyperglycemia (defined as mean morning glucose equal to or greater than 180 mg/dl) after adjusting for gestational age. They also found an association of hyperglycemia (both severe early and persistent) with NEC stage II/III (OR 9.49, 95% CI 1.52 to 59.3) after adjusting for age and male gender, and an association of mortality with early (OR 15.7, 95% CI 3.74 to 65.9) or persistent (OR 30.4, 95% CI 3.37 to 274) severe hyperglycemia.…”

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confidence: 99%

“…Kao et al 4 analyzed outcomes of mortality and infection based on the degree of hyperglycemia and its duration in ELBW infants. Blanco et al 5 analyzed factors that could be conceived as causal for hyperglycemia separate from those that could be conceived as secondary to hyperglycemia. Whether the association of hyperglycemia with mortality or sepsis and whether the association of hyperglycemia with ROP is causal remain to be assessed by a randomized trial.…”

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Multivariate analysis of hyperglycemia in extremely low birth weight infants

Soghier

Brion

2006

J Perinatol

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Multivariate analysis of hyperglycemia in extremely low birth weight infants

Soghier

Brion

2006

J Perinatol

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Spectral-Domain Optical Coherence Tomographic Assessment of Severity of Cystoid Macular Edema in Retinopathy of Prematurity

Maldonado¹,

O’Connell²,

Ascher³

et al. 2012

Arch Ophthalmol

111

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Objective To investigate whether the severity of cystoid macular edema (CME) in neonates who were 31 to 36 weeks’ postmenstrual age, as viewed by spectral-domain optical coherence tomography (SD-OCT) imaging, predicts the severity of retinopathy of prematurity (ROP) or is related to systemic health. Design Of 62 prematurely born neonates in a prospective institutional review board–approved study, 42 met the following inclusion criteria: at least 1 SD-OCT imaging session prior to 37 weeks’ postmenstrual age and prior to ROP laser treatment, if a laser treatment was performed, and an ophthalmic ROP examination at or after 41 weeks’ postmenstrual age, evidence of complete retinal vascularization in zone III, or documentation through telephone report of such information after transfer of care. Measures of CME severity, including central foveal thickness, retinal layer thicknesses, and foveal-to-parafoveal thickness ratio in 1 eye per subject, were compared with ROP outcomes: laser treatment, maximum plus disease, and maximum ROP stage. Systemic health factors were also correlated. Results Cystoid macular edema was present in 50% of neonates. Multiple elongated cystoid structures within the inner nuclear layer were most common. The presence of CME was not associated with ROP outcomes. The central foveal thickness, the thickness of the inner retinal layers, and the foveal-to-parafoveal thickness ratio were higher in eyes that required laser treatment or that developed plus disease or ROP stage 3. Cystoid macular edema was not clearly associated with systemic factors. Conclusions Cystoid macular edema is common in premature infants screened for ROP before 37 weeks’ postmenstrual age, with the most common SD-OCT phenotype of a bulging fovea from multiple elongated cystoid spaces. Detection of CME is not associated with ROP severity; however, tomographic thickness measurements could potentially predict a higher risk of requiring laser treatment or developing plus disease or ROP stage 3. Systemic health factors are probably not related to the development of CME.

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Early Enhanced Parenteral Nutrition, Hyperglycemia, and Death Among Extremely Low-Birth-Weight Infants

et al. 2015

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IMPORTANCE Efforts to optimize early parenteral nutrition (PN) in extremely low-birth-weight (ELBW) infants to promote growth and development may increase hyperglycemia risk. Recent studies have identified an association between early hyperglycemia and adverse outcomes in ELBW infants. OBJECTIVES To examine the prevalence of early hyperglycemia and clinical outcomes among ELBW infants before (2002-2005) and after (2006-2011) the implementation of an early enhanced PN protocol and to assess the independent effects of early enhanced PN and early hyperglycemia on mortality. DESIGN, SETTING, AND PARTICIPANTS Observational cohort study in a level III neonatal intensive care unit. Prospectively collected clinical data in the neonatal intensive care unit's medical database, nutritional information, and blood glucose levels were merged for analysis. All ELBW infants born between January 1, 2002, and December 31, 2011, without lethal malformations and still alive at 12 hours of life were eligible for inclusion in the study. MAIN OUTCOMES AND MEASURES Mortality was the main outcome measure. Severe hyperglycemia was defined as 2 consecutive blood glucose levels exceeding 216 mg/dL at least 3 hours apart. A multivariable logistic regression model was applied to determine the independent effects of early enhanced PN and hyperglycemia on mortality. RESULTS In total, 343 infants were included in the study, 129 in a historical comparison group before the enhanced PN protocol and 214 in the early enhanced PN group. Baseline characteristics were similar between the study groups. After the introduction of early enhanced PN, the prevalence of severe hyperglycemia during the first week of life was higher in the early enhanced PN group (11.6% [15 of 129] vs 41.6% [89 of 214], P < .001), as was the mortality (10.9% [14 of 129] vs 24.3% [52 of 214], P = .003). When adjusting for background characteristics, treatment, and nutritional data, early severe hyperglycemia remained a strong independent risk factor for death (odds ratio, 4.68; 95% CI, 1.82-12.03), together with gestational age (odds ratio, 0.62; 95% CI, 0.49-0.79). CONCLUSIONS AND RELEVANCE The implementation of an enhanced PN protocol was correlated with an increased prevalence of severe hyperglycemia and higher mortality. In the multivariable analysis, an enhanced PN regimen per se was not predictive of mortality, whereas early severe hyperglycemia remained strongly predictive of death. To avoid detrimental effects on outcomes in ELBW infants, the optimal composition of early PN to avoid postnatal growth failure must be carefully balanced against hyperglycemia risk.

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

Cited by 125 publications

References 30 publications

Multivariate analysis of hyperglycemia in extremely low birth weight infants

Multivariate analysis of hyperglycemia in extremely low birth weight infants

Spectral-Domain Optical Coherence Tomographic Assessment of Severity of Cystoid Macular Edema in Retinopathy of Prematurity

Early Enhanced Parenteral Nutrition, Hyperglycemia, and Death Among Extremely Low-Birth-Weight Infants

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