Abstract
To determine whether a continuous insulin infusion improves glucose tolerance in extremely low birth weight infants, we conducted a prospective, randomized trial in 24 neonates 4 to 14 days old (mean birth weight 772.9±128 gm; mean gestational age 26.3±1.6 weeks). Infants who had glucose intolerance were randomly assigned to receive either intravenous glucose and total parenteral nutrition with insulin through a microliter-sensitive pump or standard intravenous therapy alone. One infant assigned to recelve insulin never required it. The groups were similar in birth weight, gestational age, race, gender, medical condition, and energy intake before the study. The mean duratio of therapy was 14.6 days (range 7 to 21 days). During the study, the 11 insulin-treated infants tolerated higher glucose infusion rates (20.1±2.5 vs 13.2±3.2 mg/kg/min (1.1±0.1 vs 0.7±0.2 mmol/L); p<0.01), had greater nonprotein energy intake (124.7±18 vs 86.0±6 kcal/kg/day; p<0.01), and had better weight gain (20.1±12.1 vs 7.8±5.1 gm/kg/day; p<0.01) than the 12 control infants. The incidence of hypoglycemia, electrolyte imbalance, chronic lung disease, and death did not differ between groups. We conclude that a controlled insulin infusion improves and sustains glucose tolerance, facilitates provision of calories, and enhances weight gain in glucose-intolerant premature infants.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 921-927 |
| Number of pages | 7 |
| Journal | The Journal of pediatrics |
| Volume | 118 |
| Issue number | 6 |
| DOIs | |
| State | Published - Jun 1991 |
Funding
Hyperglycemia often develops when premature babies are given parenteral alimentation in amounts to meet requirements for sustained growth. 1-5 The incidence of hyperglycemia has been estimated to be between 45% and 80% in Presented in part at the Annual Meeting of the American Pediatric Society and the Society for Pediatric Research, Anaheim, Calif.; May 1990. Supported in part by National Institutes of Health grants 1P O119070, and H D 18014, and the Children's Memorial Institute for Education and Research. Submitted for publication Sept. 11, 1990; accepted Dec. 10, 1990. Reprint requests: James W. Collins, Jr~, MD, MPH, Division of Neonatology, Children's Memorial Hospital, 2300 Children's Plaza, Chicago, IL 60614. 9/23/27287 premature infants who survive the first week of life. 5' 6 The pathogenesis is not understood, but it is believed to be related to the premature infant's inefficient insulin secretory capability and tissue insensitivity to insulin.2 , 4, 7-10 Uncontrolled clinical experience suggests that insulin
ASJC Scopus subject areas
- Pediatrics, Perinatology, and Child Health
