Insulin infusion with parenteral nutrition in extremely low birth weight infants with hyperglycemia

Binder, Nancy D.; Raschko, Paula K.; Benda, Gerda I.; Reynolds, John W.

doi:10.1016/s0022-3476(89)80797-8

Cited by 99 publications

(40 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Use of insulin has been shown to increase glucose tolerance [22][23][24][25][26][27], resulting in increased weight gain [23,25,27], but also commonly results in increased incidence of hypoglycaemia (low blood glucose concentration) [28][29][30], which is also dangerous. In adult intensive care even a single hypoglycaemic episode has been associated with increased risk of mortality [31][32][33], while in neonatal intensive care hypoglycaemia as been associated with adverse neurological outcomes [34,35].…”

Section: Introductionmentioning

confidence: 99%

Insulin kinetics and the Neonatal Intensive Care Insulin–Nutrition–Glucose (NICING) model

Dickson

Pretty

Alsweiler

et al. 2017

Mathematical Biosciences

View full text Add to dashboard Cite

Background: Models of human glucose-insulin physiology have been developed for a range of uses, with similarly different levels of complexity and accuracy. STAR (Stochastic Targeted) is a modelbased approach to glycaemic control. Elevated blood glucose concentrations (hyperglycaemia) are a common complication of stress and prematurity in very premature infants, and have been associated with worsened outcomes and higher mortality. This research identifies and validates the model parameters for model-based glycaemic control in neonatal intensive care.

show abstract

Section: Introductionmentioning

confidence: 99%

Insulin kinetics and the Neonatal Intensive Care Insulin–Nutrition–Glucose (NICING) model

Dickson

Pretty

Alsweiler

et al. 2017

Mathematical Biosciences

View full text Add to dashboard Cite

show abstract

“…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%

Development of blood glucose control for extremely premature infants

Compte

Chase

Lynn

et al. 2011

Computer Methods and Programs in Biomedicine

View full text Add to dashboard Cite

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

show abstract

“…3,4 In infants with necrotizing enterocolitis (NEC), hyperglycemia has also been associated with increased late mortality. 5 However, studies examining the impact of hyperglycemia on infectious morbidity and mortality in low birth weight infants are sparse.…”

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

View full text Add to dashboard Cite

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.

show abstract

Insulin infusion with parenteral nutrition in extremely low birth weight infants with hyperglycemia

Cited by 99 publications

References 29 publications

Insulin kinetics and the Neonatal Intensive Care Insulin–Nutrition–Glucose (NICING) model

Insulin kinetics and the Neonatal Intensive Care Insulin–Nutrition–Glucose (NICING) model

Development of blood glucose control for extremely premature infants

Hyperglycemia and morbidity and mortality in extremely low birth weight infants

Contact Info

Product

Resources

About