Can early hyperglycemia affect the morbidity/mortality of very low birth weight premature infants?

Abstract

Background. The study aimed to examine the effect of early hyperglycemia on the morbidity/mortality of very low birth weight premature infants. Methods. This retrospective study included all premature infants with gestational age ≤32 gestational weeks, hospitalized at the Department of Intensive Neonatal Care, Clinical Center Kragujevac, during the period 2017-2019. Hyperglycemia was defined as glycemia of ≥12 mmol/l in one measurement, or > 10 mmol/l in two measurements, at repeated intervals of 2-4 hours. Glycemia was determined from capillary blood, using a gas analyzer of Gem Premier 3000, during the first 7 days of life. Continuous intravenous insulin infusion was administered after ineffective glucose restriction at glycemic values of > 14 mmol/l. Results. Patients with normoglycemia (41/72 (56.94%)) and hyperglycemia (31/72 (43.06%)) did not differ in gender, gestational age, mode of delivery and antenatal administration of steroids, while birth weight had a tendency to be lower in the hyperglycemic group (p=0.052). Hyperglycemia was significantly associated with a low APGAR score at the fifth minute (p=0.048), necrotizing enterocolitis (p=0.011), and shorter duration of mechanical ventilation (p=0.006). Hyperglycemia was associated with significantly more frequent fatal outcomes (35.5%) when compared with the normoglycemic group (4.9%). Accordingly, these patients required inotropic (r=0.036) and insulin therapy (r < 0.001) more often. Retinopathy of prematurity, bronchopulmonary dysplasia and sepsis did not correlate with hyperglycemia in our study. Intraventricular hemorrhage of the first degree was more often associated with normoglycemia in premature infants on prolonged mechanical ventilation while more severe intracranial hemorrhage was more common in the hyperglycemic group but did not result in statistical significance due to the small number of patients. Conclusions. Monitoring glucose levels in the blood of very low birth weight premature infants is clinically important because abnormalities in glucose homeostasis can have serious short-term and long-term consequences.

Incidence and Risk Factors for Glucose Disturbances in Premature Infants

“…Hyperglycemia is one of the most common metabolic conditions in extremely low birth weight infants (ELBW). It has been associated with significant morbidity and mortality, including intraventricular hemorrhage, retinopathy of prematurity, necrotizing enterocolitis, and abnormal neurologic examination at two years of age [5][6][7][8]. Several risk factors contribute to the development of hyperglycemia in preterm infants, including gestational age, low birth weight, stress, excessive glucose administration, parenteral nutrition, and the administration of some drugs, such as corticosteroids, phenytoin, or theophylline [9][10][11].…”

A Nomogram model for predicting early hyperglycemia in premature infants

“…Two prospective studies found that hyperglycemia is associated with intracranial hemorrhage. [23,24]. High blood glucose concentrations increase the risk of early death and grade 3 or 4 intraventricular bleeding [25].…”

“…One study showed that mechanical ventilation increases the chance of developing hyperglycemia three times(P = 0.032) [4]. A study showed that hyperglycemia was signi cantly associated with a shorter duration of mechanical ventilation (P = 0.006) [24]. This may be related to stress hyperglycemia in premature infants induced by mechanical ventilation.…”

A Compact Control System to Enable Automated Operation of Microfluidic Bioanalytical Assays

“…Neonatology is one area where automated microfluidic devices may be particularly effective. Preterm newborns may have as little as 50 mL of total blood volume and are at an elevated risk for a number of health conditions including hypoglycemia [ 6 ], infections [ 7 ] and jaundice [ 8 , 9 ]. To improve health outcomes, preterm infants must be carefully monitored and screened for these conditions by measuring biomarkers in the blood.…”