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Hyperglycemia in Extremely Preterm Infants—Insulin Treatment, Mortality and Nutrient Intakes

Zamir, Itay ; Tornevi, Andreas ; Abrahamsson, Thomas ; Ahlsson, Fredrik ; Engström, Eva ; Hallberg, Boubou ; Hansen-Pupp, Ingrid LU ; Sjöström, Elisabeth Stoltz and Domellöf, Magnus (2018) In Journal of Pediatrics 200. p.1-110
Abstract

Objective: To explore the prevalence of hyperglycemia and the associations between nutritional intakes, hyperglycemia, insulin treatment, and mortality in extremely preterm infants. Study design: Prospectively collected data from the Extremely Preterm Infants in Sweden Study (EXPRESS) was used in this study and included 580 infants born <27 gestational weeks during 2004-2007. Available glucose measurements (n = 9850) as well as insulin treatment and nutritional data were obtained retrospectively from hospital records for the first 28 postnatal days as well as 28- and 70-day mortality data. Results: Daily prevalence of hyperglycemia >180 mg/dL (10 mmol/L) of up to 30% was observed during the first 2 postnatal weeks, followed by a... (More)

Objective: To explore the prevalence of hyperglycemia and the associations between nutritional intakes, hyperglycemia, insulin treatment, and mortality in extremely preterm infants. Study design: Prospectively collected data from the Extremely Preterm Infants in Sweden Study (EXPRESS) was used in this study and included 580 infants born <27 gestational weeks during 2004-2007. Available glucose measurements (n = 9850) as well as insulin treatment and nutritional data were obtained retrospectively from hospital records for the first 28 postnatal days as well as 28- and 70-day mortality data. Results: Daily prevalence of hyperglycemia >180 mg/dL (10 mmol/L) of up to 30% was observed during the first 2 postnatal weeks, followed by a slow decrease in its occurrence thereafter. Generalized additive model analysis showed that increasing parenteral carbohydrate supply with 1 g/kg/day was associated with a 1.6% increase in glucose concentration (P <.001). Hyperglycemia was associated with more than double the 28-day mortality risk (P <.01). In a logistic regression model, insulin treatment was associated with lower 28- and 70-day mortality when given to infants with hyperglycemia irrespective of the duration of the hyperglycemic episode (P <.05). Conclusions: Hyperglycemia is common in extremely preterm infants throughout the first postnatal month. Glucose infusions seem to have only a minimal impact on glucose concentrations. In the EXPRESS cohort, insulin treatment was associated with lower mortality in infants with hyperglycemia. Current practices of hyperglycemia treatment in extremely preterm infants should be reevaluated and assessed in randomized controlled clinical trials.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
neonatology, nutrition
in
Journal of Pediatrics
volume
200
pages
1 - 110
publisher
Academic Press
external identifiers
  • pmid:29731360
  • scopus:85046719751
ISSN
0022-3476
DOI
10.1016/j.jpeds.2018.03.049
language
English
LU publication?
yes
id
9b6af9b6-3b68-41f0-bbbd-f9643ff2795d
date added to LUP
2018-05-25 15:03:43
date last changed
2020-10-27 04:26:02
@article{9b6af9b6-3b68-41f0-bbbd-f9643ff2795d,
  abstract     = {<p>Objective: To explore the prevalence of hyperglycemia and the associations between nutritional intakes, hyperglycemia, insulin treatment, and mortality in extremely preterm infants. Study design: Prospectively collected data from the Extremely Preterm Infants in Sweden Study (EXPRESS) was used in this study and included 580 infants born &lt;27 gestational weeks during 2004-2007. Available glucose measurements (n = 9850) as well as insulin treatment and nutritional data were obtained retrospectively from hospital records for the first 28 postnatal days as well as 28- and 70-day mortality data. Results: Daily prevalence of hyperglycemia &gt;180 mg/dL (10 mmol/L) of up to 30% was observed during the first 2 postnatal weeks, followed by a slow decrease in its occurrence thereafter. Generalized additive model analysis showed that increasing parenteral carbohydrate supply with 1 g/kg/day was associated with a 1.6% increase in glucose concentration (P &lt;.001). Hyperglycemia was associated with more than double the 28-day mortality risk (P &lt;.01). In a logistic regression model, insulin treatment was associated with lower 28- and 70-day mortality when given to infants with hyperglycemia irrespective of the duration of the hyperglycemic episode (P &lt;.05). Conclusions: Hyperglycemia is common in extremely preterm infants throughout the first postnatal month. Glucose infusions seem to have only a minimal impact on glucose concentrations. In the EXPRESS cohort, insulin treatment was associated with lower mortality in infants with hyperglycemia. Current practices of hyperglycemia treatment in extremely preterm infants should be reevaluated and assessed in randomized controlled clinical trials.</p>},
  author       = {Zamir, Itay and Tornevi, Andreas and Abrahamsson, Thomas and Ahlsson, Fredrik and Engström, Eva and Hallberg, Boubou and Hansen-Pupp, Ingrid and Sjöström, Elisabeth Stoltz and Domellöf, Magnus},
  issn         = {0022-3476},
  language     = {eng},
  month        = {05},
  pages        = {1--110},
  publisher    = {Academic Press},
  series       = {Journal of Pediatrics},
  title        = {Hyperglycemia in Extremely Preterm Infants—Insulin Treatment, Mortality and Nutrient Intakes},
  url          = {http://dx.doi.org/10.1016/j.jpeds.2018.03.049},
  doi          = {10.1016/j.jpeds.2018.03.049},
  volume       = {200},
  year         = {2018},
}