Elsevier

The Journal of Pediatrics

Volume 151, Issue 6, December 2007, Pages 611-617.e1
The Journal of Pediatrics

Original article
Early Elective Insulin Therapy Can Reduce Hyperglycemia and Increase Insulin-Like Growth Factor-I Levels in Very Low Birth Weight Infants

https://doi.org/10.1016/j.jpeds.2007.04.068Get rights and content

Objective

To investigate the use of insulin throughout the first week of life in very low birth weight (VLBW) infants (birth weight <1.5 kg) to improve glucose control and increase insulin-like growth factor-I (IGF-I) levels. IGF-I is the dominant hormone involved in fetal growth, and low levels have been implicated in neonatal morbidities, such as retinopathy of prematurity.

Study design

In this pilot randomized controlled study (n = 16), the intervention group received insulin (0.025 U/kg/hr) on days 1 to 7, with 20% dextrose to maintain normoglycemia. Control infants received standard neonatal care. All infants received continuous glucose monitoring.

Results

The intervention and standard care groups had similar mean gestational age (± standard deviation), 26.2 (± 2.5) vs 26.9 (± 2.7) weeks, and birth weight, 0.79 (± 0.26) vs 0.73 (± 0.16) kg. The standard care infants were hyperglycemic (sensor glucose >10 mmol/L [180 mg/dL]) for 35.9% of the study period, compared with 7.6% for the insulin-treated infants (P = .035). The duration of time with hypoglycemia (<2.6 mmol/L [47 mg/dL]) did not differ between the 2 groups (P = .746). The insulin-treated group had a 2.4-fold increase in mean IGF-I bioactivity (P = .005).

Conclusions

Early insulin therapy improves blood glucose control and increases IGF-I bioactivity levels. This could result in less morbidity associated with hyperglycemia and reduced IGF-I levels.

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

References (37)

  • L.S. Kao et al.

    Hyperglycemia and morbidity and mortality in extremely low birth weight infants

    J Perinatol

    (2006)
  • S.P. Hays et al.

    Hyperglycemia is a risk factor for early death and morbidity in extremely low birth weight infants

    Pediatrics

    (2006)
  • R. Latham et al.

    The association of diabetes and glucose control with surgical site infections among cardiothoracic surgery patients

    Infect Control Hosp Epidemiol

    (2001)
  • G. Van den Berghe et al.

    Intensive insulin therapy in critically ill patients

    N Engl J Med

    (2001)
  • P.E. Cryer

    Hypoglycemia: the limiting factor in the glycemic management of the critically ill?

    Diabetologia

    (2006)
  • P. Heron et al.

    Insulin infusions in infants of birth weight less than 1250 g and with glucose intolerance

    Aust Paediatr J

    (1988)
  • S. Ostertag et al.

    Insulin pump therapy in the very low birth weight infant

    Pediatrics

    (1986)
  • W. Meetze et al.

    Hyperglycemia in extremely-low birth weight infants

    Biol Neonate

    (1998)
  • Cited by (0)

    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.

    View full text