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Strictly controlled glucose infusion rates are associated with a reduced risk of hyperglycaemia in extremely low birth weight preterm infants
Author(s) -
Stensvold Hans Jorgen,
Lang Astri M.,
Strommen Kenneth,
Abrahamsen Tore G.,
Ogland Bjorn,
Pripp Are H.,
Ronnestad Arild E.
Publication year - 2018
Publication title -
acta paediatrica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.772
H-Index - 115
eISSN - 1651-2227
pISSN - 0803-5253
DOI - 10.1111/apa.14164
Subject(s) - medicine , odds ratio , low birth weight , neonatal intensive care unit , logistic regression , parenteral nutrition , birth weight , hypoglycemia , insulin , pediatrics , pregnancy , genetics , biology
Aim We evaluated a strict strategy that aimed to avoid fluctuations in glucose infusion rates ( GIR s) and assessed the independent effects of maximal daily GIR s on the hyperglycaemia risk among extremely low birth weight ( ELBW ) infants receiving early enhanced parenteral nutrition. Methods This study comprised all ELBW infants admitted to the neonatal intensive care unit of Oslo University Hospital Rikshospitalet, Norway, before (2007–2009) and after (2012–2013) implementing a strict GIR strategy. Severe hyperglycaemia was defined as two consecutive blood glucose values over 12 mmol/L. Maximum daily GIR s (mg/kg/min) were categorised into low (<5.1), intermediate (5.1–7.0) or high (>7.0). Mixed effects logistic regression modelling for repeated measurements was applied to investigate independent determinants of hyperglycaemia. Results We included 1293 treatment days for 195 infants. The maximum daily GIR decreased (6.3 versus 5.8 mg/kg/min), while mean daily glucose and energy intakes were maintained in the post‐strategy period. The prevalence of severe hyperglycaemia (48% versus 23%), insulin use (39% versus 16%) and mortality (26% versus 10%) fell. Intermediate GIR (odds ratio 2.11) and high GIR (odds ratio 2.85) were significant independent predictors of severe hyperglycaemia compared to low GIR . Conclusion A strict GIR strategy reduced the risk of severe hyperglycaemia and adverse outcomes.