Mitanchez-Mokhtari D, Lahlou N, Kieffer F, Magny JF, Roger M, Voyer M. Both relative insulin resistance and defective islet [beta]-cell processing of proinsulin are responsible for transient hyperglycemia in extremely preterm infants. Pediatrics. 2004;113(3):537-541.
Extremely low birthweight (ELBW) infants (<30 weeks gestation) often experience hyperglycemia early in life, resulting in the need for insulin therapy in order to regulate their blood glucose levels. Studies have shown that the concurrent use of total parenteral nutrition during this time may also contribute to the hyperglycemic reaction. The researchers investigated how hyperglycemia occurs in ELBW infants and the means to treat it effectively.
Researchers in Paris, France, randomly assigned a total of 48 infants to one of three groups: treatment group of ELBW infants (n = 15), control group of ELBW infants (n = 12), and a control group of healthyAQ1 neonates (n = 21). The characteristics of all of the premature infants were similar. All infants were tested three times for hyperglycemia via blood test. All of the treatment group infants received total parenteral nutrition.
Treatment of hyperglycemia was accomplished using insulin infusion. During this time, additional blood samples were measured for serum insulin, proinsulin, and C-peptide of insulin to determine the extent of effectiveness of the insulin therapy.
The results showed that there were no differences between the hyperglycemic premature infants and their control counterparts regarding insulin and C-peptide levels; however, these levels were lower in the full term infants. These data imply that hyperglycemic infants are unable to produce sufficient insulin and that premature infants, in general, are resistant to their own insulin. The researchers stated that these findings may indicate that continuous insulin infusion is the best way to treat hyperglycemic ELBW infants because their basic blood glucose production is immature.