Survey of the management of neonatal hyperglycaemia in Australasia

Alsweiler, Jane; Kuschel, Carl A; Bloomfield, Frank H.

doi:10.1111/j.1440-1754.2007.01158.x

Cited by 57 publications

(46 citation statements)

References 19 publications

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“…The model-based controller was trialled in simulation with targets of 4 mmol/L, 5 mmol/L, 6 mmol/L, 7 mmol/L and 8 mmol/L, which represents a range of target glucose concentrations likely to be encountered in neonatal critical care [37].…”

Section: Controller Developmentmentioning

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: Controller Developmentmentioning

confidence: 99%

“…Similarly, Alsweiler et al [37] demonstrated a wide range of responses from different clinical units when questioned on glycaemic control targets. Hence, a control system needs to handle different glucose targets to comply with local practices.…”

Section: Introductionmentioning

confidence: 95%

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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show abstract

“…Elevated blood glucose levels (BG) (Hyperglycaemia) is a common complication of prematurity and stress in neonatal intensive care, and while definitions and thresholds vary [11], studies show that 30-70% of very/extremely low birth weight infants have at least one BG> 8 mmol/L [12][13][14][15][16]. Hyperglycaemia is associated with increased mortality [15][16][17], and morbidity/complications in this cohort [15][16][17][18][19][20][21], but there is still debate over whether hyperglycaemia causes increased morbidity, or is reflective of worsened condition.…”

Section: Introductionmentioning

confidence: 99%

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

Dickson

Pretty

Alsweiler

et al. 2017

Mathematical Biosciences

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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.

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“…Moderately elevated blood glucose levels are recently more tolerated or recommended [63] because of the fear of hypoglycemia and higher nursing effort frequently associated with TGC [64]. A recent study by Alsweiler and colleagues [65] found that while all surveyed neonatal units would consider use of insulin for hyperglycemia, the threshold for commencing insulin infusions varied, as well as the choice of glycemic management using altered dextrose infusion rates. Most units reported little to no hypoglycemia, and these findings agreed with previous surveys that found a lack of consensus on the management of neonatal hyperglycemia, possibly reflecting the lack of data available in this area [65].…”

Section: Discussionmentioning

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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Survey of the management of neonatal hyperglycaemia in Australasia

Abstract: There is a wide variation in the management of neonatal hyperglycaemia between tertiary neonatal units in Australasia. This reflects the paucity of data available in this area. Further research on the management of neonatal hyperglycaemia is needed.

Cited by 57 publications

References 19 publications

Development of blood glucose control for extremely premature infants

Development of blood glucose control for extremely premature infants

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

Modeling the glucose regulatory system in extreme preterm infants

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