Does continuous insulin infusion improve glycaemic control and nutrition in hyperglycaemic very low birth weight infants?

Kairamkonda, Venkatesh

doi:10.1136/adc.2005.087502

Cited by 14 publications

(8 citation statements)

References 29 publications

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“…The percentage of hypoglycaemic patients (36.8% or 14/38) and their times in hypoglycaemia ( ^ 40 mg/dl) were consistent with results in the Cambridge pilot study [22] . Regarding intermittent sampling, our figures are also comparable to others (reviewed by Kairamkonda [23] ), with a maximum of 2.8% of measurements in the hypoglycaemic range. This is in spite of different cut-off points used by different authors.…”

Section: Discussionsupporting

confidence: 76%

Continuous Glucose Monitoring in Infants of Very Low Birth Weight

et al. 2008

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Objectives: To evaluate the feasibility and efficacy of a continuous glucose monitoring system (CGMS) in a population of infants of very low birth weight (VLBW). Study Design: Infants weighing ≤1,500 g and of ≤32 weeks of gestation were recruited within 24 h of delivery. A subcutaneous sensor connected to a CGMS was inserted and maintained for 7 days or until dysfunction. Therapeutic management followed the usual standard protocols. Results: 38 patients (21 male) were included over 17 months. Their mean gestational age was 27.5 ± 2.0 weeks and their mean birth weight was 958.3 ± 205.5 g. Their perinatal histories and complications during admission were unremarkable for extremely premature babies. Continuous monitoring lasted an average of 7.84 ± 1.99 days per patient. Hyperglycaemia was detected in 22 (57.90%) patients and it lasted a mean of 20.33 ± 30.13 h, while 14 (36.8%) presented with hypoglycaemia for a mean of 2.45 ± 2.3 h. Conclusions: The CGMS gave a safe and useful estimate of glucose levels in VLBW infants, revealing abnormal glucose levels at a much higher rate than expected by usual sampling. However, it was not able to provide real-time glucose concentration data. CGMS may be very useful in providing information on the role of hyper- and hypoglycaemia on short- and long-term outcomes in VLBW infants.

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Section: Discussionsupporting

confidence: 76%

Continuous Glucose Monitoring in Infants of Very Low Birth Weight

et al. 2008

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“…Limited trials of glucose control using insulin in neonates have been reported [7], [11], [34]- [39], and insulin therapy did help to improve glucose tolerance in these limited trials. Insulin therapy in preterm neonates is gaining wider acceptance [40], [41], but still carries the risk of hypoglycemia and possible neurological complications [3].…”

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confidence: 99%

Blood Glucose Prediction Using Stochastic Modeling in Neonatal Intensive Care

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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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“…[10] Treatment can be accomplished either by decreasing the infusion rate, decreasing the glucose concentration or initiating an insulin infusion. Since the basal metabolic requirements of a premature are roughly 60 kcal/kg per day, [11] the dextrose concentration should not be decreased to less than 5% due to concerns about insuffi cient calories and infusion of a signifi cantly hypo-osmolar solution.…”

Section: Carbohydratementioning

confidence: 99%