J Korean Med Sci.  2013 Mar;28(3):450-460. 10.3346/jkms.2013.28.3.450.

Permissive Hyperglycemia in Extremely Low Birth Weight Infants

Affiliations
  • 1Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. wonspark@skku.edu

Abstract

The aim of this study is to evaluate the outcomes of permissive hyperglycemia up to < 300 mg/dL in extremely-low-birth-weight infants (ELBWIs). We retrospectively reviewed the medical records of 260 live-born ELBWIs at Samsung Medical Center between 2004 and 2008, grouped according to peak blood glucose level and management during the first 14 days of life. The groups were normoglycemia (N), blood glucose < or = 200 mg/dL; permissive hyperglycemia (P), blood glucose 201-299 mg/dL without insulin treatment; treated hyperglycemia (T), blood glucose > or = 300 mg/dL with insulin. Only 15% of patients were grouped as N, with 39% as P and 46% as T. Although P had lower birth weight, P had a similar daily calorie and glucose intake as well as urine output compared to N. There was no significant correlation between blood glucose level and urine output on day 7. Compared to N, P showed faster weight gain and similar mortality, morbidities, and long-term neurological outcomes. Permissive hyperglycemia up to < 300 mg/dL without insulin treatment during the first 14 days of life is not associated with osmotic diuresis or increased mortality or morbidities, suggesting that it is not detrimental in ELBWIs.

Keyword

Hyperglycemia; Prognosis; Infant, Extremely Low Birth Weight

MeSH Terms

Blood Glucose/analysis
Demography
Gestational Age
Humans
Hyperglycemia/*blood/drug therapy/mortality
Hypoglycemic Agents/therapeutic use
Infant, Extremely Low Birth Weight
Infant, Newborn
Infant, Premature, Diseases/*blood/mortality/pathology
Intensive Care Units, Neonatal
Odds Ratio
Retrospective Studies
Time Factors
Blood Glucose
Hypoglycemic Agents

Figure

  • Fig. 1 Strategy for the management of neonatal hyperglycemia in extremely-low-birth-weight infants during the first 14 days of life.

  • Fig. 2 Flow diagram showing the distribution of extremely-low-birth-weight infants according to diagnosis and treatment of hyperglycemia during the first 14 days of life.

  • Fig. 3 Hyperglycemia during the first 14 days of life. Daily mean value of peak blood glucose (A) and daily incidence of hyperglycemic episodes (blood glucose > 200 mg/dL) (B) during the first 14 days of life, stratified by group. Data are expressed as mean +95% upper confidence interval. N, normoglycemia group; P, permissive hyperglycemia group; T, hyperglycemia group treated with insulin. *P < 0.05 vs N. †P < 0.05 vs P.

  • Fig. 4 Nutrition during the first 14 days of life. Total glucose (A), amino acid (B), lipid (C) and caloric (D) intake in each group during the first 14 days of life. Data are mean ± SEM. N, normoglycemia group; P, permissive hyperglycemia group; T, hyperglycemia group treated with insulin. *P < 0.05 vs N. †P < 0.05 vs P.

  • Fig. 5 Fluid balance during the first 14 days of life. Daily urine output (A), fluid intake (B), and weight loss and regain (C) in each group during the first 14 days of life. Data are mean ± SEM. N, normoglycemia group; P, permissive hyperglycemia group; T, hyperglycemia group treated with insulin. *P < 0.05 vs N. †P < 0.05 vs P.

  • Fig. 6 Electrolytes and renal function during the first 14 days of life. Serum sodium (A), serum potassium (B), blood urea nitrogen (C) and serum creatinine (D) on days 7 and 14. Data are mean ± SEM. N, normoglycemia group; P, permissive hyperglycemia group; T, hyperglycemia group treated with insulin. *P < 0.05 vs N. †P < 0.05 vs P.

  • Fig. 7 Correlation between blood glucose levels, urine output, or urine stick glucose. Spearman correlation analysis between daily urine output and blood glucose level (A), urine stick glucose and blood glucose level (B), and urine output according to peak urine stick glucose results (C) on day 7. *P < 0.05 between every urine stick glucose levels.

  • Fig. 8 Growth velocity at 7, 14, and 28 days. Growth velocity = ([body weight - birth weight]/birth weight) × 100. Data are mean ± SEM. N, normoglycemia group; P, permissive hyperglycemia group; T, hyperglycemia group treated with insulin. *P < 0.05 vs N; †P < 0.05 vs P.


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