Hyperglycemia and morbidity and mortality in extremely low birth weight infants

Kao, Lillian S.; Morris, BH; Lally, Kevin P.; Stewart, Christine; Huseby, Valerie; Kennedy, Kathleen A.

doi:10.1038/sj.jp.7211593

Cited by 168 publications

(126 citation statements)

References 28 publications

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“…A laboratory study manipulating insulin and glucose independently showed that the observed benefits of intensive insulin therapy required maintenance of normoglycemia. 15 Both studies in this issue of Journal of Perinatology 4,5 found a strong association between hyperglycemia and low gestational age, whereas the association between hyperglycemia and low birth weight was either less strong 4 or not significant. 5 Kao et al 4 found a significant association between their primary outcome variable, that is, a composite outcome of either mortality or late-onset culture-proven infection (odds ratio (OR) 5.07, 95% confidence interval (CI) 1.06 to 24.3) and early (the first 3 days) severe hyperglycemia (defined as mean morning glucose equal to or greater than 180 mg/dl) after adjusting for gestational age.…”

mentioning

confidence: 94%

“…15 Both studies in this issue of Journal of Perinatology 4,5 found a strong association between hyperglycemia and low gestational age, whereas the association between hyperglycemia and low birth weight was either less strong 4 or not significant. 5 Kao et al 4 found a significant association between their primary outcome variable, that is, a composite outcome of either mortality or late-onset culture-proven infection (odds ratio (OR) 5.07, 95% confidence interval (CI) 1.06 to 24.3) and early (the first 3 days) severe hyperglycemia (defined as mean morning glucose equal to or greater than 180 mg/dl) after adjusting for gestational age. They also found an association of hyperglycemia (both severe early and persistent) with NEC stage II/III (OR 9.49, 95% CI 1.52 to 59.3) after adjusting for age and male gender, and an association of mortality with early (OR 15.7, 95% CI 3.74 to 65.9) or persistent (OR 30.4, 95% CI 3.37 to 274) severe hyperglycemia.…”

mentioning

confidence: 94%

“…They also found an association of hyperglycemia (both severe early and persistent) with NEC stage II/III (OR 9.49, 95% CI 1.52 to 59.3) after adjusting for age and male gender, and an association of mortality with early (OR 15.7, 95% CI 3.74 to 65.9) or persistent (OR 30.4, 95% CI 3.37 to 274) severe hyperglycemia. Kao et al 4 found no significant association of hyperglycemia with total number of days of mechanical ventilation among survivors and length of stay for survivors not transferred to another facility. Blanco et al 5 after adjusting for gestational age, birth weight, postnatal steroids and sepsis, showed an inverse association between hyperglycemia and chorioamnionitis (OR 0.10, 95% CI 0.01 -0.64).…”

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confidence: 97%

“…1,2 The relationship between hyperglycemia and morbidity (e.g., intraventricular hemorrhage, which could be mediated by changes in osmolal concentration) 3 and mortality in this population is still not clearly defined. In this month's Journal of Perinatology, Kao et al 4 and Blanco et al 5 describe multivariate analyses of this relationship in large samples of ELBW infants from single-site centers.…”

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confidence: 99%

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Multivariate analysis of hyperglycemia in extremely low birth weight infants

Soghier

Brion

2006

J Perinatol

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confidence: 94%

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confidence: 94%

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confidence: 97%

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confidence: 99%

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Multivariate analysis of hyperglycemia in extremely low birth weight infants

Soghier

Brion

2006

J Perinatol

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“…23 We have recently reported that persistent severe hyperglycemia (serum glucose>180 mg per 100 ml) in the first days after birth is associated with a higher risk of death and sepsis among ELBW infants. 24 Most of the infants completed the full 7-day study intervention and appeared to tolerate the SWGD reasonably well, although the intervention was transiently interrupted in about 80% of them. It is rather common among ELBW infants to have residuals or lack of tolerance when enteral feedings are begun.…”

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confidence: 89%

Randomized trial of sterile water by gavage drip in the fluid management of extremely low birth weight infants

Stewart¹,

Morris

Huseby³

et al. 2008

J Perinatol

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Objective: To determine whether extremely low birth weight infants who receive enteral sterile water have a reduction in treated patent ductus arteriosus or death by 28 days compared to infants with routine management.Study Design: A total of 214 infants were enrolled and randomized by 36 h of age to receive up to 50 ml kg À1 per day of enteral sterile water (n ¼ 109) for 7 days or routine fluid management (n ¼ 104). Patent ductus arteriosus treatment was defined as either indomethacin treatment or surgical ligation.Result: The proportion of infants with a treated patent ductus arteriosus or death at <28 days of age was 63% in the sterile water group vs 64% in the control group (relative risk 0.99, 95% confidence interval 0.81 to 1.22). There were no differences in the proportion of infants in the sterile water group vs control group with a treated patent ductus arteriosus (55 vs 48%), death (21 vs 28%), necrotizing enterocolitis or death (24 vs 32%), or bronchopulmonary dysplasia or death at <28 days (80 vs 77%). Daily mean glucose levels were significantly higher (P ¼ 0.04) in control infants than sterile water infants. Conclusion:The use of sterile water did not decrease the incidence of patent ductus arteriosus or other adverse clinical outcomes. The role of enteral sterile water in the fluid management of extremely low birth weight infants remains uncertain.

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Early Enhanced Parenteral Nutrition, Hyperglycemia, and Death Among Extremely Low-Birth-Weight Infants

et al. 2015

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IMPORTANCE Efforts to optimize early parenteral nutrition (PN) in extremely low-birth-weight (ELBW) infants to promote growth and development may increase hyperglycemia risk. Recent studies have identified an association between early hyperglycemia and adverse outcomes in ELBW infants. OBJECTIVES To examine the prevalence of early hyperglycemia and clinical outcomes among ELBW infants before (2002-2005) and after (2006-2011) the implementation of an early enhanced PN protocol and to assess the independent effects of early enhanced PN and early hyperglycemia on mortality. DESIGN, SETTING, AND PARTICIPANTS Observational cohort study in a level III neonatal intensive care unit. Prospectively collected clinical data in the neonatal intensive care unit's medical database, nutritional information, and blood glucose levels were merged for analysis. All ELBW infants born between January 1, 2002, and December 31, 2011, without lethal malformations and still alive at 12 hours of life were eligible for inclusion in the study. MAIN OUTCOMES AND MEASURES Mortality was the main outcome measure. Severe hyperglycemia was defined as 2 consecutive blood glucose levels exceeding 216 mg/dL at least 3 hours apart. A multivariable logistic regression model was applied to determine the independent effects of early enhanced PN and hyperglycemia on mortality. RESULTS In total, 343 infants were included in the study, 129 in a historical comparison group before the enhanced PN protocol and 214 in the early enhanced PN group. Baseline characteristics were similar between the study groups. After the introduction of early enhanced PN, the prevalence of severe hyperglycemia during the first week of life was higher in the early enhanced PN group (11.6% [15 of 129] vs 41.6% [89 of 214], P < .001), as was the mortality (10.9% [14 of 129] vs 24.3% [52 of 214], P = .003). When adjusting for background characteristics, treatment, and nutritional data, early severe hyperglycemia remained a strong independent risk factor for death (odds ratio, 4.68; 95% CI, 1.82-12.03), together with gestational age (odds ratio, 0.62; 95% CI, 0.49-0.79). CONCLUSIONS AND RELEVANCE The implementation of an enhanced PN protocol was correlated with an increased prevalence of severe hyperglycemia and higher mortality. In the multivariable analysis, an enhanced PN regimen per se was not predictive of mortality, whereas early severe hyperglycemia remained strongly predictive of death. To avoid detrimental effects on outcomes in ELBW infants, the optimal composition of early PN to avoid postnatal growth failure must be carefully balanced against hyperglycemia risk.

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Hyperglycemia and morbidity and mortality in extremely low birth weight infants

Cited by 168 publications

References 28 publications

Multivariate analysis of hyperglycemia in extremely low birth weight infants

Multivariate analysis of hyperglycemia in extremely low birth weight infants

Randomized trial of sterile water by gavage drip in the fluid management of extremely low birth weight infants

Early Enhanced Parenteral Nutrition, Hyperglycemia, and Death Among Extremely Low-Birth-Weight Infants

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