OBJECTIVE: To investigate the use of insulin throughout the first week of life in very low birth weight (VLBW) infants (birth weight <1.5 kg) to improve glucose control and increase insulin-like growth factor-I (IGF-I) levels. IGF-I is the dominant hormone involved in fetal growth, and low levels have been implicated in neonatal morbidities, such as retinopathy of prematurity. STUDY DESIGN: In this pilot randomized controlled study (n = 16), the intervention group received insulin (0.025 U/kg/hr) on days 1 to 7, with 20% dextrose to maintain normoglycemia. Control infants received standard neonatal care. All infants received continuous glucose monitoring. RESULTS: The intervention and standard caregroups had similar mean gestational age (+/- standard deviation), 26.2 (+/- 2.5) vs 26.9 (+/- 2.7) weeks, and birth weight, 0.79 (+/- 0.26) vs 0.73 (+/- 0.16) kg. The standard care infants were hyperglycemic (sensor glucose >10 mmol/L [180 mg/dL]) for 35.9% of the study period, compared with 7.6% for the insulin-treated infants (P = .035). The duration of time with hypoglycemia (<2.6 mmol/L [47 mg/dL]) did not differ between the 2 groups (P = .746). The insulin-treated group had a 2.4-fold increase in mean IGF-I bioactivity (P = .005). CONCLUSIONS:Early insulin therapy improves blood glucose control and increases IGF-I bioactivity levels. This could result in less morbidity associated with hyperglycemia and reduced IGF-I levels.
RCT Entities:
OBJECTIVE: To investigate the use of insulin throughout the first week of life in very low birth weight (VLBW) infants (birth weight <1.5 kg) to improve glucose control and increase insulin-like growth factor-I (IGF-I) levels. IGF-I is the dominant hormone involved in fetal growth, and low levels have been implicated in neonatal morbidities, such as retinopathy of prematurity. STUDY DESIGN: In this pilot randomized controlled study (n = 16), the intervention group received insulin (0.025 U/kg/hr) on days 1 to 7, with 20% dextrose to maintain normoglycemia. Control infants received standard neonatal care. All infants received continuous glucose monitoring. RESULTS: The intervention and standard care groups had similar mean gestational age (+/- standard deviation), 26.2 (+/- 2.5) vs 26.9 (+/- 2.7) weeks, and birth weight, 0.79 (+/- 0.26) vs 0.73 (+/- 0.16) kg. The standard care infants were hyperglycemic (sensor glucose >10 mmol/L [180 mg/dL]) for 35.9% of the study period, compared with 7.6% for the insulin-treated infants (P = .035). The duration of time with hypoglycemia (<2.6 mmol/L [47 mg/dL]) did not differ between the 2 groups (P = .746). The insulin-treated group had a 2.4-fold increase in mean IGF-I bioactivity (P = .005). CONCLUSIONS: Early insulin therapy improves blood glucose control and increases IGF-I bioactivity levels. This could result in less morbidity associated with hyperglycemia and reduced IGF-I levels.
Authors: David Ley; Ingrid Hansen-Pupp; Aimon Niklasson; Magnus Domellöf; Lena E Friberg; Jan Borg; Chatarina Löfqvist; Gunnel Hellgren; Lois E H Smith; Anna-Lena Hård; Ann Hellström Journal: Pediatr Res Date: 2012-10-24 Impact factor: 3.756
Authors: Cameron A Gunn; Jennifer L Dickson; James N Hewett; Adrienne Lynn; Hamish J Rose; Sooji H Clarkson; Geoffrey M Shaw; J Geoffrey Chase Journal: J Diabetes Sci Technol Date: 2013-05-01
Authors: Chatarina Löfqvist; Aimon Niklasson; Eva Engström; Lena E Friberg; Cecilia Camacho-Hübner; David Ley; Jan Borg; Lois E H Smith; Ann Hellström Journal: Pediatr Res Date: 2009-05 Impact factor: 3.756
Authors: Jan Hau Lee; Christoph P Hornik; Daniela Testoni; Matthew M Laughon; C Michael Cotten; Ramiro S Maldonado; Marc R Belcastro; Reese H Clark; P Brian Smith Journal: Am J Perinatol Date: 2015-10-20 Impact factor: 3.079
Authors: N Margreth van der Lugt; Vivianne E H J Smits-Wintjens; Paul H T van Zwieten; Frans J Walther Journal: BMC Pediatr Date: 2010-07-20 Impact factor: 2.125