Continuous Insulin Intravenous Infusion Therapy for VLBW Infants

Ditzenberger, Georgia R.; Collins, Susan D.; Binder, Nancy D.

doi:10.1097/00005237-199912000-00007

Cited by 24 publications

(13 citation statements)

References 12 publications

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“…The prevalence was similar to that reported in other studies [1][2][3][4][5] . Hyperglycaemia in premature infants can cause osmotic diuresis with resultant loss of water and electrolytes leading to dehydration [5] . Hyperglycaemia is also associated with intracranial haemorrhage and death [4,14] .…”

Section: Discussionsupporting

confidence: 90%

Continuous Insulin Infusion in Hyperglycaemic Extremely-Low- Birth-Weight Neonates

May

Emmerson³

2005

Neonatology

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Background: The inability of the newborn to inhibit gluconeogenesis in response to a glucose infusion leading to insulin resistance has been postulated as an important cause of hyperglycaemia observed in premature infants. Aim: The aim of this study was to determine the efficiency and rate of response to continuous insulin infusion in improving glucose tolerance in hyperglycaemic extremely-low-birth-weight (ELBW) neonates (≤1,000 g) compared to neonates with birth weight >1,000 g (LBW). Methods: We included in the study 115 consecutive neonates in the neonatal intensive care unit who developed hyperglycaemia from January 2000 to December 2001. A standard protocol for the use of exogenous insulin infusions was commenced for all hyperglycaemic neonates. The efficiency of continuous insulin infusion was compared in two groups of infants: ELBW ≤1,000 g compared with neonates with birth weight >1,000 g (LBW). Results: The duration (hours) of insulin infusion required to normalise blood glucose level was significantly longer in the ELBW group compared to LBW group (p < 0.0001). Average insulin infusion (units/kg/h) required to maintain normoglycaemia was also significantly higher in the ELBW group (p < 0.0001). No significant difference was found in the mean amount of intravenous dextrose tolerated, mean postnatal age (hours) at which infusions were initiated and the average blood glucose recorded. ELBW infants were more likely to receive steroid administration, have surgery, higher CRIB scores and sepsis. Conclusion: Continuous insulin infusion was relatively safe and effective in the treatment of persistent hyperglycaemia in premature neonates. No serious adverse side effects of insulin therapy were noted. With the current protocol for use of exogenous insulin infusion at our unit, the response to treatment was significantly slower in the ELBW neonates. The dose of insulin infusion required to maintain normoglycaemia was also higher in this group of neonates. There may be a need for different treatment schedules for this subgroup of neonates so that normalisation of blood glucose can be achieved earlier.

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Section: Discussionsupporting

confidence: 90%

Continuous Insulin Infusion in Hyperglycaemic Extremely-Low- Birth-Weight Neonates

May

Emmerson³

2005

Neonatology

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“…Low-birth-weight neonates and preterm neonates are at the highest risk of developing hyperglycemia [5], [6], even in patients with no family history of diabetes.…”

mentioning

confidence: 99%

Blood Glucose Prediction Using Stochastic Modeling in Neonatal Intensive Care

Compte

Lee

Chase

et al. 2010

IEEE Trans. Biomed. Eng.

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Abstract-Hyperglycemia is a common metabolic problem in premature, low-birth-weight infants. Blood glucose homeostasis in this group is often disturbed by immaturity of endogenous regulatory systems and the stress of their condition in intensive care. A dynamic model capturing the fundamental dynamics of the glucose regulatory system provides a measure of insulin sensitivity (S I ). Forecasting the most probable future S I can significantly enhance real-time glucose control by providing a clinically validated/proven level of confidence on the outcome of an intervention, and thus, increased safety against hypoglycemia. A 2-D kernel model of S I is fitted to 3567 h of identified, time-varying S I from retrospective clinical data of 25 neonatal patients with birth gestational age 23 to 28.9 weeks. Conditional probability estimates are used to determine S I probability intervals. A lag-2 stochastic model and adjustments of the variance estimator are used to explore the biasvariance tradeoff in the hour-to-hour variation of S I . The model captured 62.6% and 93.4% of in-sample S I predictions within the (25th-75th) and (5th-95th) probability forecast intervals. This overconservative result is also present on the cross-validation cohorts and in the lag-2 model. Adjustments to the variance estimator found a reduction to 10%-50% of the original value provided optimal coverage with 54.7% and 90.9% in the (25th-75th) and (5th-95th) intervals. A stochastic model of S I provided conservative forecasts, which can add a layer of safety to real-time control. Adjusting the variance estimator provides a more accurate, cohortspecific stochastic model of S I dynamics in the neonate.

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“…Hyperglycemia was significant after adjustment for the other risk factors (2,(12)(13)(14)(15) . In the literature, hyperglycemia is regarded as a marker of acute critical state, reflecting its severity and insulin resistance (1,16,17) . Therefore, we are of the opinion that high concentrations of glucose in the blood should not be considered a specific risk factor for ROP, but rather, reflects the severity of the somatic condition and morphofunctional immaturity of the premature infant.…”

Section: Discussionmentioning

confidence: 99%

Influence of the blood glucose level on the development of retinopathy of prematurity in extremely premature children

Nicolaeva¹,

Sidorenko²,

Iosifovna³

2015

Arquivos Brasileiros De Oftalmologia

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Approved by the following research ethics committee: Research Ethics Committee of Pirogov Russian National research medical university, meeting date: 12.12.2011. Project number: 113. ABSTRACTPurpose: To investigate the influence of the blood glucose level on the development of retinopathy of prematurity (ROP) in extremely premature infants. Methods: Sixty-four premature infants with a gestational age of less than 30 weeks and a birth weight of less than 1500 g were included in the study. Children without ROP were allocated to Group 1 (n=14, gestational age 28.6 ± 1.4 weeks, birth weight 1162 ± 322 g), and children with spontaneous regression of ROP were allocated to Group 2 (n=32, gestational age 26.5 ± 1.2 weeks, birth weight 905 ± 224 g). Children with progressive ROP who underwent laser treatment were included in Group 3 (n=18, gestational age 25.4 ± 0.7 weeks, birth weight 763 ± 138 g). The glucose level in the capillary blood of the premature infants was monitored daily during the first 3 weeks of life. A complete ophthalmological screening was performed from the age of 1 month. The nonparametric signed-rank Wilcoxon-Mann-Whitney test was used for statistical analysis. Results:The mean blood glucose level was 7.43 ± 2.6 mmol/L in Group 1, 7.8 ± 2.7 mmol/L in Group 2, and 6.7 ± 2.6 mmol/L in Group 3. There were no significant differences in the blood glucose levels between children with and without ROP, and also between children with spontaneously regressing ROP and progressive ROP (p>0.05). Additionally, there were no significant differences in the blood glucose levels measured at the first, second, and third weeks of life (p>0.05). Conclusion:The blood glucose level is not related to the development of ROP nor with its progression or regression. The glycemic level cannot be considered as a risk factor for ROP, but reflects the severity of newborns' somatic condition and morphofunctional immaturity.

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Continuous Insulin Intravenous Infusion Therapy for VLBW Infants

Cited by 24 publications

References 12 publications

Continuous Insulin Infusion in Hyperglycaemic Extremely-Low- Birth-Weight Neonates

Continuous Insulin Infusion in Hyperglycaemic Extremely-Low- Birth-Weight Neonates

Blood Glucose Prediction Using Stochastic Modeling in Neonatal Intensive Care

Influence of the blood glucose level on the development of retinopathy of prematurity in extremely premature children

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