Itay Zamir1, Andreas Tornevi2, Thomas Abrahamsson3, Fredrik Ahlsson4, Eva Engström5, Boubou Hallberg6, Ingrid Hansen-Pupp7, Elisabeth Stoltz Sjöström8, Magnus Domellöf9. 1. Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden. Electronic address: itay.zamir@umu.se. 2. Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, Umeå University, Umeå, Sweden. 3. Department of Clinical and Experimental Medicine, Division of Pediatrics, Linköping University, Linköping, Sweden. 4. Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden. 5. Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. 6. CLINTEC Department of Neonatology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden. 7. Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Pediatrics, Lund, Sweden. 8. Department of Food and Nutrition, Umeå University, Umeå, Sweden. 9. Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden.
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 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.
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.
Authors: Megan E Paulsen; Sarah Jane Brown; Katherine M Satrom; Johannah M Scheurer; Sara E Ramel; Raghavendra B Rao Journal: Neonatology Date: 2021-08-19 Impact factor: 5.106
Authors: Emma Persad; Greta Sibrecht; Martin Ringsten; Simon Karlelid; Olga Romantsik; Tommy Ulinder; Israel Júnior Borges do Nascimento; Maria Björklund; Anneliese Arno; Matteo Bruschettini Journal: PLoS One Date: 2021-02-08 Impact factor: 3.240
Authors: Bertan Cakir; William Hellström; Yohei Tomita; Zhongjie Fu; Raffael Liegl; Anna Winberg; Ingrid Hansen-Pupp; David Ley; Ann Hellström; Chatarina Löfqvist; Lois Eh Smith Journal: JCI Insight Date: 2020-10-02