Tight glycaemic control with insulin in hyperglycaemic very low birth weight infants

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Guidelines

Tight glycaemic control with insulin in hyperglycaemic very low birth weight infants: RCT in infants born at < 30 weeks' gestation or < 1500 g with hyperglycaemia (2 consecutive BGL > 8.5 mmol/L 4 hours apart) randomly assigned to tight glycaemic control with insulin (target BGL 4–6 mmol/L) or restrictive guidelines for starting insulin (target BGL 8–10 mmol/L). Infants in the tight group had a lesser lower leg growth rate (P < 0.05), but greater head circumference growth (P < 0.0005) and greater weight gain (P < 0.001) to 36 weeks' postmenstrual age than control infants. Tight group infants had lower daily BGL and greater incidence of hypoglycaemia (BGL < 2.6 mmol/L) (25/43 vs 12/45; P < 0.01) than controls. There were no significant differences in nutritional intake or in the incidences of mortality or morbidity. The balance of risks and benefits of insulin treatment in hyperglycaemic pre-term neonates remains uncertain. (LOE II GOR D) [1].

Guidelines: ESPGHAN 2005 recommended the use of insulin should be restricted to conditions where reasonable changes in glucose infusion rate do not control marked hyperglycaemia [9]. Although this recommendation is now out of date, current evidence is consistent with this recommendation.

Pharmacokinetics

Following IV administration, the observed half-life of insulin ranges from 5 to 15 minutes [Micromedex].

References

1. Alsweiler JM, Harding JE, Bloomfield FH. Tight glycemic control with insulin in hyperglycemic preterm babies: a randomized controlled trial. Pediatrics. 2012;129:639-47.

2. Bottino M, Cowett RM, Sinclair JC. Interventions for treatment of neonatal hyperglycemia in very low birth weight infants. Cochrane Database Syst Rev. 2011:CD007453.

3. Hewson M, Nawadra V, Oliver J, Odgers C, Plummer J, Simmer K. Insulin infusions in the neonatal unit: delivery variation due to adsorption. J Paediatr Child Health. 2000;36:216-20.

4. Thompson CD, Vital-Carona J, Faustino EV. The effect of tubing dwell time on insulin adsorption during intravenous insulin infusions. Diabetes Technol Ther. 2012;14:912-6.

5. Simeon PS, Geffner ME, Levin SR, Lindsey AM. Continuous insulin infusions in neonates: pharmacologic availability of insulin in intravenous solutions. Journal of Pediatrics. 1994;124:818-20.

6. Collins JW, Jr., 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;118:921-7.

7. Meetze W, Bowsher R, Compton J, Moorehead H. Hyperglycemia in extremely- low-birth-weight infants. Biol Neonate. 1998;74:214-21.

8. Sinclair JC, Bottino M, Cowett RM. Interventions for prevention of neonatal hyperglycemia in very low birth weight infants. Cochrane Database Syst Rev. 2011:CD007615.

9. Koletzko B, Goulet O, Hunt J, Krohn K, Shamir R. 1. Guidelines on Paediatric Parenteral Nutrition of the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and the European Society for Clinical Nutrition and Metabolism (ESPEN), Supported by the European Society of Paediatric Research (ESPR). J Pediatr Gastroenterol Nutr. 2005;41 Suppl 2:S1-87.

10. Micromedex accessed 24/03/2017.

Original version Date: 3/05/2017	Author: Neonatal Medicines Formulary Consensus Group
Current Version number: 2	Current Version Date: 2/3/2020
Risk Rating: Medium	Due for Review: 2/3/2023
Approval by: DTC	Approval Date: TBA

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