Insulin for Treatment of Neonatal Hyperglycemia in Premature Infants: Prevalence over Time and Association with Outcomes

Daniela Titchiner; Chi Hornik; Robert Benjamin; Veeral Tolia; P Brian Smith; Rachel G Greenberg

doi:10.1055/a-1976-2142

Insulin for Treatment of Neonatal Hyperglycemia in Premature Infants: Prevalence over Time and Association with Outcomes

Am J Perinatol. 2022 Dec 21. doi: 10.1055/a-1976-2142. Online ahead of print.

Authors

Daniela Titchiner¹, Chi Hornik^{1

2}, Robert Benjamin³, Veeral Tolia^{4

5}, P Brian Smith^{1

2}, Rachel G Greenberg^{1

2}

Affiliations

¹ Division of Neonatology, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina.
² Duke Clinical Research Institute, Durham, North Carolina.
³ Division of Endocrinology, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina.
⁴ The MEDNAX Center for Research, Education, Quality and Safety, Sunrise, Florida.
⁵ Division of Neonatology, Department of Pediatrics, Baylor University Medical Center, Dallas, Texas.

PMID: 36356594
DOI: 10.1055/a-1976-2142

Abstract

Objective: Our objective was to determine the prevalence of insulin treatment in premature infants with hyperglycemia and evaluate the association of length of treatment with outcomes.

Study design: The study included cohort of 29,974 infants 22 to 32 weeks gestational age (GA) admitted to over 300 neonatal intensive care unit (NICU) from 1997 to 2018 and diagnosed with hyperglycemia.

Results: Use of insulin significantly decreased during the study period (p = 0.002) among studied NICUs. The percentage of hyperglycemic infants exposed to insulin ranged from 0 to 81%. Infants who received insulin were more likely to have lower GA, birth weight, 5-minute Apgar score, longer duration of stay, and require mechanical ventilation. After adjustment for GA, infants requiring insulin for >14 days were more likely to have treated retinopathy of prematurity (ROP) and develop chronic lung disease (CLD). Insulin treatment of 1 to 7 days had increased odds of death, death/ROP, and death/CLD compared with no exposure.

Conclusion: Insulin use decreased over time, and differing durations of use were associated with adverse outcomes.

Key points: · Insulin use decreased over time.. · There is a temporal relation between the duration of treatment and adverse outcomes.. · Further studies are needed to determine the efficacy and safety of insulin use..