Relationship between Insulin-Like Growth Factor I Levels, Early Insulin Treatment, and Clinical Outcomes of Very Low Birth Weight Infants - 16/04/14
, Sophie Vanhaesebrouck, PhD 3, Jan Frystyk, MD, PhD, DMSc 4, Amanda L. Ogilvy-Stuart, FRCP 2, Christine Vanhole, PhD 3, Mirjam van Weissenbruch, PhD 5, Paula Midgley, FRCPCH 6, Marta Thio, MD 7, Luc Cornette, MD 8, Bryan Gill, FRCPCH 8, Iviano Ossuetta, FRCPCH 9, Isabel Iglesias, MD 7, Claire Theyskens, MD 10, Miranda de Jong, MD 5, Jag S. Ahluwalia, FRCPCH 2, Francis de Zegher, PhD 3, David B. Dunger, MD, FMed Sci 1on behalf of the
NIRTURE Study Group∗
Abstract |
Objectives |
Insulin regulates the secretion of insulin-like growth factor I (IGF-I) in the newborn, and low levels of IGF-I have been linked to neonatal morbidity. As part of the Neonatal Insulin Replacement Therapy in Europe Trial, we investigated the impact of early insulin treatment on IGF-I levels and their relationship with morbidity and growth.
Study design |
Prospective cohort analyses of data collected as part of an international randomized controlled trial. Blood samples (days 1, 3, 7, and 28), were taken for IGF-I bioassay from 283 very low birth weight infants (<1500 g).
Results |
Early insulin treatment led to a late increase in IGF-I levels between day 7 and 28 (P = .028). In the first week of life IGF-I levels were lower in infants with early hyperglycemia; mean difference −0.10 μg/L (95% CI −0.19, −0.02, P = .02). Lower levels of IGF-I at day 28 were independently associated with an increased risk of chronic lung disease, OR 3.23 (95% CI, 1.09-9.10), and greater IGF-I levels were independently associated with better weight gain, 0.10 kg (95% CI, 0.03-0.33, P = .02).
Conclusions |
Early intervention with insulin is related to increased IGF-I levels at 28 days. Low IGF-I levels are associated with hyperglycemia, increased morbidity, and reduced growth. Increasing IGF-I levels may improve outcomes of very low birth weight infants.
Le texte complet de cet article est disponible en PDF.Keyword : CGM, CLD, IGF-I, NEC, NIRTURE, ROP, VLBW
Plan
| Sponsored by Cambridge University Hospitals National Health System Foundation Trust. Funded by an unrestricted grant from Novo Nordisk, Medtronic, Leeds General Infirmary research fund, Clinicip Consortium, University of Cambridge Department of Pediatrics, the National Institute of Health Research Cambridge Biomedical Research Institute, and National Health System Research and Development. Novo Nordisk provided the insulin aspart, and Medtronic provided the continuous glucose monitoring system and sensors. Neither Novo Nordisk nor Medtronic had any role in design of the study, the gathering of data, access to data, preparation of the manuscript or decision to publish the results. The authors declare no conflicts of interest. |
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| Registered with International Standard Randomized Controlled Trial Register: ISRCTN78428828 and European Union Drug Regulating Authorities Clinical Trials: 2004-002170-34. |
Vol 164 - N° 5
P. 1038 - mai 2014 Retour au numéro
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