Submitted to: Pediatrics
Publication Type: Peer reviewed journal
Publication Acceptance Date: 6/7/2006
Publication Date: 11/1/2006
Citation: Hays, S.P., Smith, E.O., Sunehag, A.L. 2006. Hyperglycemia is a risk factor for early death and morbidity in extremely low birth-weight infants. Pediatrics. 118:1811-1818. Interpretive Summary: Extremely low-birth weight infants (ELBW; birth weight <1000g) are dependent on nutrition by vein during their first weeks of life. However, they have a low tolerance for glucose (sugar) given by vein, which often results in too high blood sugar concentrations (hyperglycemia). This retrospective study was conducted to explore 1) the frequency of hyperglycemia in ELBW infants receiving nutrition by vein, 2) whether hyperglycemia increases the risk of early death and/or bleeds in the brain, and 3) if it results in extended hospital stays among survivors. We studied the charts of 93 ELBW infants admitted to Texas Children's Hospital during 2001. The results indicated that there is a high prevalence of hyperglycemia in ELBW infants, and that hyperglycemia is associated with increased risk of early death and bleeds in the brain, and that hyperglycemia during the first week of life increases the length of hospital stay among survivors. We conclude that prevention and treatment of hyperglycemia may improve the outcome of ELBW infants.
Technical Abstract: OBJECTIVES. The objectives of this study were to determine the prevalence of hyperglycemia in extremely low birth-weight infants and to determine whether hyperglycemia increases the risk of early adverse outcomes (death or intraventricular hemorrhage of grade 3 or 4) and/or affects the length of hospital stay among survivors without intraventricular hemorrhage. METHODS. The charts of all extremely low birth-weight infants (n = 93) admitted to Texas Children's Hospital (Houston, TX) during 2001 were reviewed. The highest daily blood glucose concentrations, highest dopamine infusion rates, highest daily percentage of inspired oxygen, and mean blood sodium concentrations were averaged over the first week of life or before death or occurrence of grade 3 or 4 intraventricular hemorrhage. Among survivors without severe intraventricular hemorrhage, the time ratio for blood glucose concentrations of >150 mg/dL was calculated. RESULTS. More than 50% of the infants had persistent blood glucose concentrations of >150 mg/dL during their first week of life. Early adverse outcomes were associated with the average highest daily blood glucose concentration through interaction with the Clinical Risk Index for Babies score and with the average highest daily percentage of inspired oxygen. The length of hospital stay was associated with the time ratio for blood glucose concentrations of >150 mg/dL through interaction with birth weight and the average highest daily percentage of inspired oxygen. CONCLUSION. These data confirm the high prevalence of hyperglycemia among parenterally fed, extremely low birth-weight infants and show that high blood glucose concentrations increase the risk of early death and grade 3 or 4 intraventricular hemorrhage and the length of hospital stay among survivors without intraventricular hemorrhage, which suggests that prevention and treatment of hyperglycemia may improve the outcomes of extremely low birth-weight infants.