Heald Alicia, Abdel-Latif Mohamed E, Kent Alison L
Australian National University Medical School, Canberra, 2601, ACT, Australia.
J Matern Fetal Neonatal Med. 2012 Nov;25(11):2415-8. doi: 10.3109/14767058.2012.699115. Epub 2012 Jun 29.
BACKGROUND/OBJECTIVE: Hyperglycaemia is common in very premature neonates and is associated with increased risk of intraventricular haemorrhage, necrotising enterocolitis, sepsis and death. Administration of insulin may risk hypoglycaemia and associated complications. To determine effects of insulin infusions in very premature infants on morbidity, mortality and long-term neurodevelopmental outcome.
Retrospective audit of 97 infants delivered at <29 weeks gestation and admitted to The Canberra Hospital NICU. Data on insulin treatment, Blood Glucose Levels (BGL's) prior and during insulin therapy, episodes of significant hypoglycaemia and neurodevelopmental outcome at 12 months corrected age was collected.
17 (17.5%) neonates received insulin. Episodes of hypoglycaemia were infrequent (1.3%, 95% CI 0.5-2.9). Multiple regression analysis showed that insulin treatment was not associated with an increased risk of retinopathy of prematurity (OR 3.6, 95% CI 0.4-32.3) or mortality (OR 1.2, 95% CI 0.29-5.0). No significant difference in 12 month neurodevelopmental or anthropometric outcomes was detected in infants who received insulin.
Insulin infusions for hyperglycaemia appear to be safe with infrequent episodes of hypoglycaemia, no increased risk of morbidity or mortality and no adverse effect on long-term neurodevelopmental outcome.
背景/目的：高血糖在极早产儿中很常见，且与脑室内出血、坏死性小肠结肠炎、败血症及死亡风险增加相关。使用胰岛素可能会有低血糖及相关并发症的风险。旨在确定对极早产儿输注胰岛素对发病率、死亡率及长期神经发育结局的影响。
对97例孕龄小于29周且入住堪培拉医院新生儿重症监护病房（NICU）的婴儿进行回顾性审计。收集了胰岛素治疗数据、胰岛素治疗前及治疗期间的血糖水平（BGL）、严重低血糖发作情况以及矫正年龄12个月时的神经发育结局。
17例（17.5%）新生儿接受了胰岛素治疗。低血糖发作不常见（1.3%，95%置信区间0.5 - 2.9）。多元回归分析显示，胰岛素治疗与早产儿视网膜病变风险增加（比值比3.6，95%置信区间0.4 - 32.3）或死亡率增加（比值比1.2，95%置信区间0.29 - 5.0）无关。接受胰岛素治疗的婴儿在12个月时的神经发育或人体测量结局方面未发现显著差异。
对于高血糖输注胰岛素似乎是安全的，低血糖发作不常见，发病率或死亡率没有增加，且对长期神经发育结局没有不良影响。
