Interventions for prevention of neonatal hyperglycemia in very low birth weight infants

Abstract

Glucose infusion rate: There is insufficient evidence from trials comparing lower with higher glucose infusion rates to inform clinical practice. Large randomized trials are needed, powered on clinical outcomes including death, major morbidities and adverse neurodevelopment.Insulin infusion: The evidence reviewed does not support the routine use of insulin infusions to prevent hyperglycemia in VLBW neonates. Further randomized trials of insulin infusion may be justified. They should enrol extremely low birth weight neonates at very high risk for hyperglycemia and neonatal death. They might use real time glucose monitors if these are validated for clinical use. Refinement of algorithms to guide insulin infusion is needed to enable tight control of glucose concentrations within the target range.

Standardised neonatal parenteral nutrition formulations – Australasian Neonatal Parenteral Nutrition Consensus update 2017

“…9 Hyperglycaemia: Hyperglycaemia (>8.3 mmol/L) is not uncommon in ELBW infants. 36 If blood glucose >10 mmol/L (moderate hyperglycaemia), 37,38 further management to control hyperglycaemia should be considered including reducing the glucose infusion rate (e.g. changing over to 7.5% Dextrose PN).…”

Standardised neonatal parenteral nutrition formulations – Australasian Neonatal Parenteral Nutrition Consensus update 2017

“…Hyperglycaemia: Hyperglycaemia (>8.3 mmol/L) is not uncommon in ELBW infants. 36 If blood glucose >10 mmol/L (moderate hyperglycaemia), 37,38 further management to control hyperglycaemia should be considered including reducing the glucose infusion rate (e.g. changing over to 7.5%…”

Standardised neonatal parenteral nutrition formulations – an Australasian group consensus 2012

“…Elevated neonatal blood glucose concentration has been linked to adverse outcomes including death [36,37], intraventricular haemorrhage [36], late onset bacterial infection [38], fungal infection [39,40], retinopathy of prematurity [41-43] and necrotizing enterocolitis [38]. Attempts to maintain glucose intake using insulin have yielded variable results [44,45]. For prevention of hyperglycaemia, a systematic review found two small trials which compared lower versus higher glucose infusion rates [45].…”

“…Attempts to maintain glucose intake using insulin have yielded variable results [44,45]. For prevention of hyperglycaemia, a systematic review found two small trials which compared lower versus higher glucose infusion rates [45]. These trials provided some evidence that a lower glucose infusion rate reduced mean blood glucose concentrations and the risk of hyperglycaemia, but had insufficient power to test for significant effects on death or major morbidities [16,46].…”