Elsevier

The Journal of Pediatrics

Volume 157, Issue 5, November 2010, Pages 715-719.e3
The Journal of Pediatrics

Original Article
Prevalence and Determinants of Hyperglycemia in Very Low Birth Weight Infants: Cohort Analyses of the NIRTURE Study

https://doi.org/10.1016/j.jpeds.2010.04.032Get rights and content

Objectives

To investigate the prevalence and determinants of hyperglycemia in the preterm population, as part of the Neonatal Insulin Therapy in Europe (NIRTURE) Trial.

Study design

We conducted prospective cohort analyses of continuous glucose monitoring data from control infants participating in an international randomized controlled trial. Data were collected from 188 very low birth weight infants (<1500 g).

Results

In the first week of life, 80% of infants had evidence of glucose levels >8 mmol/L, and 32% had glucose levels >10 mmol/L >10% of the time. Independent risk factors for hyperglycemia included increasing prematurity, small size at birth, use of inotropes, lipid infusions, and sepsis. There was a lack of association between rate of dextrose infused and risk of hyperglycemia.

Conclusion

The prevalence of hyperglycemia in the very low birth weight infant is high, with marked variability in prevalence between infants, not simply related to rates of glucose infused, but to other potentially modifiable risk factors.

Section snippets

Methods

The subjects were part of the NIRTURE Trial (ISRCTN78428828). This was an international multicenter randomized controlled study investigating the role of early insulin in VLBW infants.8 Ethical and regulatory authority approval (Eudract No 2004-002170-34) were obtained for each center, and the protocol is in the public domain.10 Infants were recruited from 8 European centers between February 2005 and August 2007. Written informed parental consent was obtained before recruitment, which was

Results

The characteristics of this cohort of 188 infants are shown in Table I. When the data for all infants were combined, the prevalence of each of the thresholds of hyperglycemia remained relatively stable for the 7-day study period (Figure 1; available at www.jpeds.com). However, there was significant variability in the prevalence of hyperglycemia in infants. Some infants did not experience any periods with glucose levels >10mmol/L, whereas other infants spent prolonged periods with sensor glucose

Discussion

We used continuous glucose monitoring to prospectively investigate the prevalence and determinants of high glucose levels in VLBW infants. It demonstrated prolonged periods of high glucose levels in VLBW infants in the first week of life, and a wide variation between infants in levels of glucose control. Both increasing gestational age and birth weight SDS were associated with a reduction in the risk of all defined thresholds of hyperglycemia. After adjustment for other predictive factors,

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Sponsored by the Cambridge University Hospitals NHS Foundation Trust. Funding was provided by an unrestricted grant from Novo Nordisk, with additional financial support from Medtronic, Leeds General Infirmary research fund, Clinicip Consortium, University of Cambridge Department of Paediatrics, the NIHR Cambridge Biomedical Research Institute, and NHS Research and Development. Novo Nordisk provided the insulin aspart, and Medtronic provided the continuous glucose monitoring system and sensors. Neither Novo Nordisk nor Medtronic had any role in design of the study, the gathering of data, access to data, preparation of the manuscript, or decision to publish the results. The authors declare no conflicts of interest.

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