Use of Insulin Glargine in the Management of Neonatal Hyperglycemia in an ELBW Infant
Use of Insulin Glargine in the Management of Neonatal Hyperglycemia in an ELBW Infant
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使用甘精胰岛素治疗 ELBW 婴儿的新生儿高血糖
DOI：
10.1542/peds.2016-1638
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发表时间：
2018
期刊：
影响因子：
8
通讯作者：
Elizabeth Y Flanigan
中科院分区：
文献类型：
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作者：
M. Hwang;R. Newman;Katherine Q. Philla;Elizabeth Y Flanigan
长效胰岛素成功控制极低出生体重儿高血糖的报告。长效胰岛素可能是治疗新生儿高血糖症的一种安全有效的替代疗法。新生儿高血糖症在极低出生体重儿（ELBW）中很常见，因为生理应激、外源性葡萄糖输注和出生后皮质类固醇治疗低血压、肾上腺功能不全和肺不成熟。已经描述了长效甘精胰岛素在治疗早产儿一过性新生儿糖尿病中的应用，但在这些报告中缺乏对其在治疗医源性新生儿高血糖症中的应用的关注。我们报告一例极低出生体重婴儿，患有严重高血糖症，常规治疗无效，但对长效皮下甘精胰岛素有良好反应。普通胰岛素和长效胰岛素的药代动力学不同。常规胰岛素在皮下注射后分解成生物活性单体，长效胰岛素在皮下注射后形成微沉淀物并在中性生理pH下逐渐释放到体内。常规胰岛素和长效胰岛素在ELBW婴儿中的药代动力学尚不清楚。然而，随着对长效胰岛素的进一步研究，它可以安全地用于新生儿高血糖症，每日一次给药，以实现一致的eugening。
Report of successful management of hyperglycemia in ELBW infant with long-acting insulin. Long-acting insulin may be a safe and effective alternative treatment for neonatal hyperglycemia. Neonatal hyperglycemia is common in extremely low birth weight (ELBW) infants because of physiologic stress, exogenous glucose infusion, and postnatal corticosteroid therapy for hypotension, adrenal insufficiency, and pulmonary immaturity. The use of long-acting insulin glargine has been described in the treatment of transient neonatal diabetes in the premature infant, but in these reports is a lack of regard to its use in the treatment of iatrogenic neonatal hyperglycemia. We present the case of an ELBW infant with significant hyperglycemia that was refractory to usual treatment but demonstrated a favorable response to long-acting subcutaneous insulin glargine. The pharmacokinetics on regular insulin and long-acting insulin are different. Regular insulin is broken down into biologically active monomers after subcutaneous injection, and long-acting insulin forms microprecipitates and is gradually released to the body at a neutral physiologic pH after subcutaneous injection. Pharmacokinetics of both regular insulin and long-acting insulin are not clear in ELBW infants. However, with further research on long-acting insulin, it can be used safely to achieve consistent euglycemia with once-daily administration in neonatal hyperglycemia.