Fellow University of Minnesota Masonic Children's Hospital Saint Paul, Minnesota, United States
Background: The relationship between early hyperglycemia and long-term health outcomes in preterm infants remains unclear. Early enhanced nutrition, despite its association with early hyperglycemia, results in better growth and neurodevelopmental (NDV) outcomes in preterm infants. Improved understanding of the relationship between glucose regulation, early nutrition, and long-term health outcomes in the preterm infant may inform early nutritional practices and treatment approaches to hyperglycemia. Objective: Describe the relationship between early hyperglycemia and growth, body composition, and NDV outcomes in preterm, very low birth weight (VLBW) infants after discharge. Design/Methods: Prospective cohort study of VLBW infants born < 32 weeks (N=87) and enrolled in a randomized trial of enhanced (increasing calories in the first week of life) or standard parenteral nutrition. Glucose values were measured ≥ twice daily during the first week of life. Hyperglycemia was defined as one glucose >200 mg/dL and was treated in both groups with reduction in glucose infusion rate (GIR) or insulin per unit protocol and at the discretion of the neonatologist. Growth, body composition, and NDV outcomes were measured using standard growth measurements, air displacement plethysmography at 4 months, and Bayley Scales of Infant Development-III at 12 months. Pearson correlation coefficients and linear regression models were used to assess the associations between hyperglycemia, GIR and growth/NDV outcomes adjusted for birth GA, sex and study arm. Results: GIR was negatively associated with duration of hyperglycemia (β -0.23, p=0.02) and insulin administration (β -0.18, p=0.04). Longer duration of hyperglycemia was associated with poorer growth at 4 months (Figure1): 4-month weight (β -0.38, p=0.01), 4-month length (β -0.27, p=0.04), 4-month fat mass (β -0.41, p=0.01), 4-month percent body fat (β -0.39, p=0.02), and also with 12-month OFC (β -0.49, p=0.002) (Figure 2). Longer duration of hyperglycemia was not associated with NDV at 12-month CA. GIR was not associated with growth, body composition, or NDV at 4- or 12-months CA.
Conclusion(s): In preterm, VLBW infants, hyperglycemia, but not GIR, was associated with worse growth and altered body composition at 4-months CA. Hyperglycemia nor GIR were associated with NDV at 12-months CA in this study. Further investigation into the inverse relationship between GIR and hyperglycemia/insulin may provide insight into optimal early nutrition strategies.
