Interventions for treatment of neonatal hyperglycemia in very low birth weight infants

Bottino, Marcela; Cowett, Richard M.; Sinclair, John C.

doi:10.1002/14651858.cd007453

Cited by 23 publications

(39 citation statements)

References 27 publications

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“…Hyperglycemia is a serious condition for the very preterm infant and insulin therapy has been used to normalize blood glucose levels. However, results are contradictory [23,47,50]. The main problem has been avoiding hypoglycemia following insulin treatment.…”

Section: Discussionmentioning

confidence: 99%

Safety aspects of longitudinal administration of IGF-I/IGFBP-3 complex in neonatal mice

Hellgren

Han

Wang

et al. 2011

Growth Hormone & IGF Research

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Section: Discussionmentioning

confidence: 99%

Safety aspects of longitudinal administration of IGF-I/IGFBP-3 complex in neonatal mice

Hellgren

Han

Wang

et al. 2011

Growth Hormone & IGF Research

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“…To combine the goals of glucose control and early total nutrition support in critically ill patients, intravenous insulin administration is used to regulate glucose levels during EN or PN. 11,16 There are many validated protocols that modulate insulin infusion rates to achieve adequate glycemic control; however, only a few of them use caloric intake as an input variable. 17 Wong et al 18 describe (in a proof of concept design) a protocol that modulates both insulin and (enteral) nutrition intake to regulate glucose levels.…”

Section: Discussionmentioning

confidence: 99%

“…Because abrupt full-dose administration of PN can induce considerable hyperglycemia, it may be wiser to introduce PN in a step-wise fashion in combination with intravenous insulin infusion. 11 In our critical care department, we use a nursecentered, computerized decision support system for insulin administration. 12,13 To optimize glucose control during the initiation of PN, we introduced a simple "step-up" rule that consisted of graded increases in the amount of PN administered, provided the patient blood glucose remained <10 mmol/L.…”

mentioning

confidence: 99%

Computer‐Assisted Glucose Regulation During Rapid Step‐Wise Increases of Parenteral Nutrition in Critically Ill Patients

Hoekstra¹,

Schoorl

Horst³

et al. 2010

J Parenter Enteral Nutr

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Background: Early delivery of calories is important in critically ill patients, and the administration of parenteral nutrition (PN) is sometimes required to achieve this goal. However, PN can induce acute hyperglycemia, which is associated with adverse outcome. We hypothesized that initiation of PN using a rapid “step‐up” approach, coupled with a computerized insulin‐dosing protocol, would result in a desirable caloric intake within 24 hours without causing hyperglycemia. Methods: In our surgical intensive care unit (ICU), glucose is regulated by a nurse‐centered computerized glucose regulation program. When adequate enteral feeding was not possible, PN was initiated according to a simple step‐up rule at an infusion rate of 10 mL/h (approximately 10 kcal/h) and subsequently increased by steps of 10 mL/h every 4 hours, provided glucose was <10 mmol/L, until the target caloric intake (1 kcal/kg/h) was reached. All glucose levels and insulin doses were collected during the step‐up period and for 24 hours after achieving target feeding. Results: In all 23 consecutive patients requiring PN, mean intake was 1 kcal/kg/h within 24 hours. Of the 280 glucose samples during the 48‐hour study period, mean ± standard deviation glucose level was 7.4 ± 1.4 mmol/L. Only 4.5% of glucose measurements during the step‐up period were transiently ≥10 mmol/L. After initiating PN, the insulin requirement rose from 1.1 ± 1.5 units/h to 2.9 ± 2.5 units/h (P < .001). Conclusions: This proof of concept study shows that rapid initiation of PN using a step‐up approach coupled with computerized glucose control resulted in adequate caloric intake within 24 hours while maintaining adequate glycemic control.

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“…50 A recent Cochrane review also determined that there is insufficient evidence to recommend early, continuous insulin infusion. 51 Finally, in a euglycemic insulin clamp model, Poindexter et al demonstrated a 3-fold increase in plasma lactate levels in ELBW infants treated with continuous insulin infusion, with no net protein anabolic effect observed. 52 Although routine early, continuous insulin infusion is not recommended, persistent hyperglycemia in the neonate receiving PN may warrant treatment with insulin.…”

Section: Questionmentioning

confidence: 98%

A.S.P.E.N. Clinical Guidelines

Arsenault¹,

Brenn²,

Kim³

et al. 2011

J Parenter Enteral Nutr

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Interventions for treatment of neonatal hyperglycemia in very low birth weight infants

Cited by 23 publications

References 27 publications

Safety aspects of longitudinal administration of IGF-I/IGFBP-3 complex in neonatal mice

Safety aspects of longitudinal administration of IGF-I/IGFBP-3 complex in neonatal mice

Computer‐Assisted Glucose Regulation During Rapid Step‐Wise Increases of Parenteral Nutrition in Critically Ill Patients

A.S.P.E.N. Clinical Guidelines

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