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首页> 外文期刊>Pediatrics: Official Publication of the American Academy of Pediatrics >Tight glycemic control with insulin in hyperglycemic preterm babies: A randomized controlled trial
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Tight glycemic control with insulin in hyperglycemic preterm babies: A randomized controlled trial

机译：高血糖早产儿胰岛素的严格血糖控制：一项随机对照试验

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OBJECTIVE: The optimal treatment of neonatal hyperglycemia is unclear. The aim of this trial was to determine whether tight glycemic control with insulin improves growth in hyperglycemic preterm infants, without increasing the incidence of hypoglycemia. METHODS: Randomized, controlled, nonblinded trial of 88 infants born at <30 weeks' gestation or <1500 g who developed hyperglycemia (2 consecutive blood glucose concentrations (BGC) >8.5 mmol/L, 4 hours apart) and were randomly assigned to tight glycemic control with insulin (target BGC 4-6 mmol/L, "tight" group) or standard practice (restrictive guidelines for starting insulin, target BGC 8-10 mmol/L, "control" group). The primary outcome was linear growth rate to 36 weeks' postmenstrual age. RESULTS: Eighty-eight infants were randomly assigned (tight group n = 43; control group n = 45). Infants in the tight group had a lesser lower leg growth rate (P < .05), but greater head circumference growth (P < .0005) and greater weight gain (P < .001) to 36 weeks'postmenstrual age than control infants. Tight group infants had lower daily BGC (median [interquartile range] 5.7 [4.8-6.7] vs 6.5 [5.1-8.2] mmol/L, P < .001) and greater incidence of hypoglycemia (BGC <2.6 mmol/L) (25/43 vs 12/45, P < .01) than controls. There were no significant differences in nutritional intake, or in the incidences of mortality or morbidity. CONCLUSIONS: Tight glycemic control with insulin in hyperglycemic preterm infants increases weight gain and head growth, but at the expense of reduced linear growth and increased risk of hypoglycemia. The balance of risks and benefits of insulin treatment in hyperglycemic preterm neonates remains uncertain.
机译：目的：新生儿高血糖的最佳治疗方法尚不清楚。该试验的目的是确定胰岛素的严格血糖控制是否可以改善高血糖早产儿的生长，而不增加低血糖的发生率。方法：一项随机，对照，无盲试验，对88名妊娠<30周或<1500 g的婴儿进行了高血糖（2个连续血糖浓度（BGC）> 8.5 mmol / L，相隔4小时），并随机分为两组。使用胰岛素（目标BGC 4-6 mmol / L，“严格”组）或标准操作（开始胰岛素的限制性指南，目标BGC 8-10 mmol / L，“对照组”）进行血糖控制。主要结局是月经后36周的线性增长率。结果：88例婴儿被随机分配（紧缩组n = 43;对照组n = 45）。紧缩组的婴儿在月经后36周龄时，其下肢生长率较低（P <.05），但头围生长较大（P <.0005），体重增加较大（P <.001），而对照组则为。紧密型婴儿的每日BGC较低（中位[四分位间距] 5.7 [4.8-6.7] vs 6.5 [5.1-8.2] mmol / L，P <.001），低血糖发生率较高（BGC <2.6 mmol / L）（25 / 43 vs 12/45，P <.01）。营养摄入量，死亡率或发病率均无显着差异。结论：对高血糖早产儿用胰岛素进行严格的血糖控制可增加体重增加和头部生长，但以降低线性增长和增加低血糖风险为代价。高血糖早产儿胰岛素治疗的风险和收益之间的平衡仍然不确定。

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