Continuous insulin infusion in hyperglycaemic very-low-birth-weight infants receiving parenteral nutrition

Continuous infusion of insulin was used to improve glucose tolerance in 30 premature (26.4±1.4 weeks) very-low-birth-weight (750±211.3 g) hyperglycaemic infants receiving parenteral nutrition. Infusion of insulin was started at 159.1±67 h of life; while glycaemia was 12.1±3.3 mmol/l. Normoglycaemia was restored within 31.4 h (range 2–134 h). A maximum insulin dose of 0.4 (range 0.07–4.2) IU/kg/h was required to control the blood glucose, the mean cumulative doses of insulin required was 3.27 IU/kg (range 0.09–18.1). The mean glucose infusion rate during insulin treatment was 20.3±1.7 g/kg/day; lipid was 4.6±1.1 g/kg/day and non-protein caloric intake 121.7±16.5 kcal/kg/day. Infants reach 85 kcal/kg/day of non-protein energy intake at 179.5±71.2 h after birth. During continuous insulin infusion, enteral feeding was started in all infants at 124.9±75.8 h of life. Insulin was continued for 317.7±196.6 h. Only two infants lost weight during the first week of treatment, the remaining infant gained weight steadily. In conclusion, continuous insulin infusion can rapidly and safely improve intravenous glucose tolerance, allowing higher caloric intake and growth in very-low-birth-weight infants who develop hyperglycaemia during total parenteral nutrition.