Hyperglycemia in preterm infants: should we use insulin for tighter glucose control?

A randomized study from New Zealand of hyperglycemic preterm infants compared the use of insulin to achieve tight glycemic control (blood glucose target 72 – 108 mg/dl, 4 – 6 mmol/L)  to more restrictive usage of insulin (target blood glucose range  144 – 180 mg/dl, 8-10 mmol/L). The primary outcome was linear growth rate to 36 weeks postmenstrual age. Compared to infants in the restrictive group, infants in the tight glycemic control group actually had less growth of the lower leg, but a greater growth in head circumference and weight gain. However they also had a higher incidence of hypoglycemia – almost 60%. There were no differences in mortality or morbidity between the two groups.

Tight glycemic control with insulin in hyperglycemic preterm infants. Alsweller et al, 2012.