Original articleEarly Elective Insulin Therapy Can Reduce Hyperglycemia and Increase Insulin-Like Growth Factor-I Levels in Very Low Birth Weight Infants
Section snippets
Study Design
Infants were recruited from 2 centers, the Rosie Maternity Hospital and the Luton and Dunstable Hospital NHS Trust. Inclusion criteria were birth weight <1.5 kg, age at recruitment <24 hours, and existing arterial access to allow blood sampling. An infant was excluded if the mother had any history of diabetes (prepregnancy or gestational) or if the infant had a major congenital anomaly. Of the eligible infants, approximately 55% were recruited for the study. Approximately 10% of all eligible
Results
A total of 17 infants (10 male, 7 female) with birth weight <1.5 kg and requiring intensive care were recruited within 24 hours of birth and monitored for up to 7 days. Eight infants were randomized to control, and 9 were randomized to early insulin treatment. There was 1 male infant (in the intervention arm) in whom there were significant protocol violations (treatment with sliding-scale insulin, with 20% dextrose not used according to the study protocol); thus this infant was excluded from
Discussion
The results of this pilot study confirm the high prevalence and duration of hyperglycemia during the first 7 days of life in VLBW infants requiring intensive care despite the use of standard intensive care guidelines to monitor and treat such episodes. These findings also support our hypothesis that hyperglycemia in VLBW newborns can be prevented by the early elective initiation of insulin therapy, and that continuous insulin infusions can be used without increasing the prevalence of
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Advances in nutrition of the newborn infant
2017, The LancetCitation Excerpt :These findings have led to attempts to increase circulating insulin and IGF-1 concentrations to improve postnatal growth in very preterm infants. Plasma IGF-1 concentrations are increased by early elective insulin treatment in infants with very low birthweight85 but not by tight glycaemic control with insulin in preterm infants with hyperglycaemia.47 A continuous infusion of IGF-1 and IGFBP-3 in extremely preterm infants is safe in the short term,86 but additional research is needed to determine neonatal outcomes and long-term safety.
Insulin kinetics and the Neonatal Intensive Care Insulin–Nutrition–Glucose (NICING) model
2017, Mathematical BiosciencesLow phosphatemia in extremely low birth weight neonates: A risk factor for hyperglycemia?
2016, Clinical NutritionPerformance and safety of STAR glycaemic control in neonatal intensive care: Further clinical results including pilot results from a new protocol implementation
2014, IFAC Proceedings Volumes (IFAC-PapersOnline)Relationship between insulin-like growth factor i levels, early insulin treatment, and clinical outcomes of very low birth weight infants
2014, Journal of PediatricsCitation Excerpt :This study also demonstrates a significant independent relationship between early hyperglycemia and low IGF-I levels and an association between low IGF-I levels and CLD and impaired growth, respectively, at 28 days independent of gestational age and birth weight SDS. In a smaller pilot study, comparing 8 VLBW infants on elective insulin and 8 on standard care, we observed a stimulatory effect of elective insulin on serum IGF-I and on growth.7 Thus, the present lack of difference in IGF-I levels between the 2 study arms and lack of impact of intervention on growth8 in the first week was surprising, but may be multifactorial.
External validation and sub-cohort analysis of stochastic forecasting models in NICU cohorts
2013, Biomedical Signal Processing and ControlCitation Excerpt :However, glucose restriction [21] deprives the neonate of energy vital for growth and development [20], and is therefore not ideal. The use of insulin infusions to treat hyperglycaemia and/or promote growth has shown positive outcomes including reduced proteolysis, improved glucose tolerance, increased insulin-like growth factor (IGF-I) levels, and improved caloric intake and weight gain [6–8]. However, many insulin trials were unsuccessful in safely providing glycaemic control due to increased hypoglycaemia [8,9].
The equipment required for continuous glucose monitoring was provided by Medtronic Ltd, Watford, Hertfordshire, UK.
- 1
K.B. was supported by a SPARKS Research Fellowship.
- 2
J.F. was supported by a grant from the Danish Research Council for Health and Disease.