Abstract
Objective:
The purpose of this study was to determine the association between hyperglycemia and mortality and late-onset infections (>72?h) in extremely low birth weight (ELBW) infants.
Study design:
Retrospective analysis of a prospective cohort study of 201 ELBW infants who survived greater than 3 days after birth. Mean morning glucose levels were categorized as normoglycemia (<120?mg/dl), mild-moderate hyperglycemia (120 to 179?mg/dl) and severe hyperglycemia (⩾180?mg/dl). Hyperglycemia was further divided into early (first 3 days of age) and persistent (first week of age). Logistic regression was performed to assess whether hyperglycemia was associated with either mortality or late-onset culture-proven infection, measured after 3 and 7 days of age.
Results:
Adjusting for age, the odds ratio (OR) for either dying or developing a late infection was 5.07 (95% confidence interval (CI): 1.06 to 24.3) for infants with early severe hyperglycemia and 6.26 (95% CI: 0.73 to 54.0) for infants with persistent severe hyperglycemia. Adjusting for age, both severe early and persistent hyperglycemia were associated with increased mortality. Among survivors, there was no significant association between hyperglycemia and length of mechanical ventilation or length of hospital stay. Persistent severe hyperglycemia was associated with the development of Stage II/III necrotizing enterocolitis, after adjusting for age and male gender (OR: 9.49, 95% CI: 1.52 to 59.3).
Conclusion:
Severe hyperglycemia in the first few days after birth is associated with increased odds of death and sepsis in ELBW infants.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Buy this article
- Purchase on SpringerLink
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Ertl T, Gyarmati J, Gaal V, Szabo I . Relationship between hyperglycemia and retinopathy of prematurity in very low birth weight infants. Biol Neonate 2005; 89 (1): 56–59.
Garg R, Agthe AG, Donohue PK, Lehmann CU . Hyperglycemia and retinopathy of prematurity in very low birth weight infants. J Perinatol 2003; 23 (3): 186–194.
Binder ND, Raschko PK, Benda GI, Reynolds JW . Insulin infusion with parenteral nutrition in extremely low birth weight infants with hyperglycemia. J Pediatr 1989; 114 (2): 273–280.
Mena P, Llanos A, Uauy R . Insulin homeostasis in the extremely low birth weight infant. Semin Perinatol 2001; 25 (6): 436–446.
Hall NJ, Peters M, Eaton S, Pierro A . Hyperglycemia is associated with increased morbidity and mortality rates in neonates with necrotizing enterocolitis. J Pediatr Surg 2004; 39 (6): 898–901; discussion 898–901.
van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M et al. Intensive insulin therapy in the critically ill patients. N Engl J Med 2001; 345 (19): 1359–1367.
Yendamuri S, Fulda GJ, Tinkoff GH . Admission hyperglycemia as a prognostic indicator in trauma. J Trauma 2003; 55 (1): 33–38.
Furnary AP, Wu Y, Bookin SO . Effect of hyperglycemia and continuous intravenous insulin infusions on outcomes of cardiac surgical procedures: the Portland Diabetic Project. Endocr Pract 2004; 10 (Suppl 2): 21–33.
Collins Jr JW, Hoppe M, Brown K, Edidin DV, Padbury J, Ogata ES . A controlled trial of insulin infusion and parenteral nutrition in extremely low birth weight infants with glucose intolerance. J Pediatr 1991; 118 (6): 921–927.
Meetze W, Bowsher R, Compton J, Moorehead H . Hyperglycemia in extremely-low-birth-weight infants. Biol Neonate 1998; 74 (3): 214–221.
Ng SM, May JE, Emmerson AJ . Continuous insulin infusion in hyperglycaemic extremely-low-birth-weight neonates. Biol Neonate 2005; 87 (4): 269–272.
Dweck HS, Cassady G . Glucose intolerance in infants of very low birth weight. I. Incidence of hyperglycemia in infants of birth weights 1100 grams or less. Pediatrics 1974; 53 (2): 189–195.
Louik C, Mitchell AA, Epstein MF, Shapiro S . Risk factors for neonatal hyperglycemia associated with 10% dextrose infusion. Am J Dis Child 1985; 139 (8): 783–786.
Vaucher YE, Walson PD, Morrow III G . Continuous insulin infusion in hyperglycemic, very low birth weight infants. J Pediatr Gastroenterol Nutr 1982; 1 (2): 211–217.
Hodgman JE, Barton L, Pavlova Z, Fassett MJ . Infection as a cause of death in the extremely-low-birth-weight infant. J Matern Fetal Neonatal Med 2003; 14 (5): 313–317.
Faustino EV, Apkon M . Persistent hyperglycemia in critically ill children. J Pediatr 2005; 146 (1): 30–34.
Srinivasan V, Spinella PC, Drott HR, Roth CL, Helfaer MA, Nadkarni V . Association of timing, duration, and intensity of hyperglycemia with intensive care unit mortality in critically ill children. Pediatr Crit Care Med 2004; 5 (4): 329–336.
Gore DC, Chinkes D, Heggers J, Herndon DN, Wolf SE, Desai M . Association of hyperglycemia with increased mortality after severe burn injury. J Trauma 2001; 51 (3): 540–544.
Krinsley JS . Association between hyperglycemia and increased hospital mortality in a heterogeneous population of critically ill patients. Mayo Clin Proc 2003; 78 (12): 1471–1478.
Stranders I, Diamant M, van Gelder RE, Spruijt HJ, Twisk JW, Heine RJ et al. Admission blood glucose level as risk indicator of death after myocardial infarction in patients with and without diabetes mellitus. Arch Intern Med 2004; 164 (9): 982–988.
Weekers F, Giulietti AP, Michalaki M, Coopmans W, Van Herck E, Mathieu C et al. Metabolic, endocrine, and immune effects of stress hyperglycemia in a rabbit model of prolonged critical illness. Endocrinology 2003; 144 (12): 5329–5338.
Esposito K, Nappo F, Marfella R, Giugliano G, Giugliano F, Ciotola M et al. Inflammatory cytokine concentrations are acutely increased by hyperglycemia in humans: role of oxidative stress. Circulation 2002; 106 (16): 2067–2072.
Krogh-Madsen R, Moller K, Dela F, Kronborg G, Jauffred S, Pedersen BK . Effect of hyperglycemia and hyperinsulinemia on the response of IL-6, TNF-alpha, and FFAs to low-dose endotoxemia in humans. Am J Physiol Endocrinol Metab 2004; 286 (5): E766–E772.
Losser MR, Bernard C, Beaudeux JL, Pison C, Payen D . Glucose modulates hemodynamic, metabolic, and inflammatory responses to lipopolysaccharide in rabbits. J Appl Physiol 1997; 83 (5): 1566–1574.
Yu WK, Li WQ, Li N, Li JS . Influence of acute hyperglycemia in human sepsis on inflammatory cytokine and counterregulatory hormone concentrations. World J Gastroenterol 2003; 9 (8): 1824–1827.
Rassias AJ, Givan AL, Marrin CA, Whalen K, Pahl J, Yeager MP . Insulin increases neutrophil count and phagocytic capacity after cardiac surgery. Anesth Analg 2002; 94 (5): 1113–1119 table of contents.
Speert DP, Silva Jr J . Abnormalities of in vitro lymphocyte response to mitogens in diabetic children during acute ketoacidosis. Am J Dis Child 1978; 132 (10): 1014–1017.
Golden SH, Peart-Vigilance C, Kao WH, Brancati FL . Perioperative glycemic control and the risk of infectious complications in a cohort of adults with diabetes. Diabetes Care 1999; 22 (9): 1408–1414.
Acknowledgements
We acknowledge Dr Fernando Moya, Director of Neonatology at New Hanover Regional Medical Center and Professor of Pediatrics at University of North Carolina, for his valuable comments and suggestions on the study.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kao, L., Morris, B., Lally, K. et al. Hyperglycemia and morbidity and mortality in extremely low birth weight infants. J Perinatol 26, 730–736 (2006). https://doi.org/10.1038/sj.jp.7211593
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/sj.jp.7211593
Keywords
This article is cited by
-
Glucose-regulatory hormones and growth in very preterm infants fed fortified human milk
Pediatric Research (2024)
-
Hyperglycemia and prematurity: a narrative review
Pediatric Research (2023)
-
Continuous subcutaneous insulin infusion via an insulin pump in extremely premature neonates—a case series
Intensive Care Medicine – Paediatric and Neonatal (2023)
-
Prematurity at less than 24 weeks of gestation is a risk for prolonged hyperglycemia in extremely low-birth weight infants
Endocrine (2020)
-
Prevalence and prognostic value of plasma glucose abnormalities among full-term and late-preterm neonates with sepsis
Egyptian Pediatric Association Gazette (2019)