Hyperglycemia in Extremely Preterm Infants Insulin Treatment, Mortality and Nutrient Intakes
Hyperglycemia in Extremely Preterm Infants Insulin Treatment, Mortality and Nutrient Intakes
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DOI：
10.1016/j.jpeds.2018.03.049
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发表时间：
2018-09-01
影响因子：
5.1
通讯作者：
Domellof, Magnus
中科院分区：
文献类型：
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作者：
Zamir, Itay;Tornevi, Andreas;Domellof, Magnus
目的探讨极早产儿高血糖的发生率及其与营养摄入、高血糖、胰岛素治疗和死亡率之间的关系。本研究采用前瞻性研究设计，收集瑞典极早产儿研究(EXPRESS)资料，其中580名出生时血糖值为180 mg/dL(10 mmoL/L)的婴儿出生后2周内血糖水平高达30%，之后发生率缓慢下降。广义加性模型分析显示，每天增加1g/kg的非肠外碳水化合物供应与血糖浓度增加1.6%相关(P<；.001)。高血糖与28天死亡风险的两倍以上相关(P<；.01)。在Logistic回归模型中，无论高血糖发作持续的时间长短，胰岛素治疗与高血糖婴儿28天和70天的死亡率降低有关(P<；0.05)。结论极早产儿出生后1个月内高血糖是常见的。葡萄糖输注对葡萄糖浓度的影响似乎很小。在EXPRESS队列中，胰岛素治疗与高血糖婴儿死亡率降低有关。目前治疗极早产儿高血糖的做法应该在随机对照临床试验中重新评估和评估。
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 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.