Pilot study of a model-based approach to blood glucose control in very-low-birthweight neonates

BMC Pediatrics

J Geoffrey Chase⁴  Geoffrey M Shaw²  Christopher G Pretty⁴  Jessica Lin³  Adrienne M Lynn¹  Aaron J Le Compte⁴ 

[1] MBChB, FRACP, Neonatal Department, Christchurch Women’s Hospital, Christchurch, New Zealand;MbChB, FJFICM, Department of Intensive Care, Christchurch Hospital, Christchurch School of Medicine and Health Science, University of Otago, Otago, New Zealand;Department of Medicine, University of Otago, Otago, New Zealand;Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand

关键词: Insulin sensitivity;    Control;    Insulin;    Premature birth;    Hyperglycemia;   

Others  :  1170707
DOI  :  10.1186/1471-2431-12-117

 received in 2012-02-21, accepted in 2012-07-26,  发布年份 2012

【 摘 要 】

Background

Hyperglycemia often occurs in premature, very low birthweight infants (VLBW) due to immaturity of endogenous regulatory systems and the stress of their condition. Hyperglycemia in neonates has been linked to increased morbidities and mortality and occurs at increasing rates with decreasing birthweight. In this cohort, the emerging use of insulin to manage hyperglycemia has carried a significant risk of hypoglycemia. The efficacy of blood glucose control using a computer metabolic system model to determine insulin infusion rates was assessed in very-low-birth-weight infants.

Methods

Initial short-term 24-hour trials were performed on 8 VLBW infants with hyperglycemia followed by long-term trials of several days performed on 22 infants. Median birthweight was 745 g and 760 g for short-term and long-term trial infants, and median gestational age at birth was 25.6 and 25.4 weeks respectively. Blood glucose control is compared to 21 retrospective patients from the same unit who received insulin infusions determined by sliding scales and clinician intuition. This study was approved by the Upper South A Regional Ethics Committee, New Zealand (ClinicalTrials.gov registration NCT01419873).

Results

Reduction in hyperglycemia towards the target glucose band was achieved safely in all cases during the short-term trials with no hypoglycemic episodes. Lower median blood glucose concentration was achieved during clinical implementation at 6.6 mmol/L (IQR: 5.5 – 8.2 mmol/L, 1,003 measurements), compared to 8.0 mmol/L achieved in similar infants previously (p < 0.01). No significant difference in incidence of hypoglycemia during long-term trials was observed (0.25% vs 0.25%, p = 0.51). Percentage of blood glucose within the 4.0 – 8.0 mmol/L range was increased by 41% compared to the retrospective cohort (68.4% vs 48.4%, p < 0.01).

Conclusions

A computer model that accurately captures the dynamics of neonatal metabolism can provide safe and effective blood glucose control without increasing hypoglycemia.

Trial Registration

ClinicalTrials.gov registration NCT01419873

【 授权许可】

   
2012 Le Compte et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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