Hyperglycemia in Extremely Preterm Infants—Insulin Treatment, Mortality and Nutrient Intakes - 23/08/18
, Andreas Tornevi, PhD 2, Thomas Abrahamsson, MD, PhD 3, Fredrik Ahlsson, MD, PhD 4, Eva Engström, MD, PhD 5, Boubou Hallberg, MD, PhD 6, Ingrid Hansen-Pupp, MD, PhD 7, Elisabeth Stoltz Sjöström, RD, PhD 8, Magnus Domellöf, MD, PhD 1Abstract |
Objective |
To explore the prevalence of hyperglycemia and the associations between nutritional intakes, hyperglycemia, insulin treatment, and mortality in extremely preterm infants.
Study design |
Prospectively collected data from the Extremely Preterm Infants in Sweden Study (EXPRESS) was used in this study and included 580 infants born <27 gestational weeks during 2004-2007. Available glucose measurements (n = 9850) as well as insulin treatment and nutritional data were obtained retrospectively from hospital records for the first 28 postnatal days as well as 28- and 70-day mortality data.
Results |
Daily prevalence of hyperglycemia >180 mg/dL (10 mmol/L) of up to 30% was observed during the first 2 postnatal weeks, followed by a slow decrease in its occurrence thereafter. Generalized additive model analysis showed that increasing parenteral carbohydrate supply with 1 g/kg/day was associated with a 1.6% increase in glucose concentration (P < .001). Hyperglycemia was associated with more than double the 28-day mortality risk (P < .01). In a logistic regression model, insulin treatment was associated with lower 28- and 70-day mortality when given to infants with hyperglycemia irrespective of the duration of the hyperglycemic episode (P < .05).
Conclusions |
Hyperglycemia is common in extremely preterm infants throughout the first postnatal month. Glucose infusions seem to have only a minimal impact on glucose concentrations. In the EXPRESS cohort, insulin treatment was associated with lower mortality in infants with hyperglycemia. Current practices of hyperglycemia treatment in extremely preterm infants should be reevaluated and assessed in randomized controlled clinical trials.
Le texte complet de cet article est disponible en PDF.Keywords : neonatology, nutrition
Abbreviations : CRIB, EXPRESS, IVH, NEC, SGA
Plan
| Supported by The Swedish Research Council (Vetenskapsrådet; 2016-02095) and Västerbotten County Council (ALF; VLL-640871). No involvement was made by these organizations in the study design; the collection, analysis, and interpretation of data; the writing of the report; and the decision to submit the paper for publication. The authors declare no conflicts of interest. |
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| Portions of this study were presented at the 1st Congress of the joint European Neonatal Societies (jENS), September 16-20, 2015, Budapest, Hungary and the 49th meeting of the European Society of Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN), May 25-28, 2016, Athens, Greece. |
Vol 200
P. 104 - septembre 2018 Retour au numéro
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