Prematurity at less than 24 weeks of gestation is a risk for prolonged hyperglycemia in extremely low-birth weight infan
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ORIGINAL ARTICLE
Prematurity at less than 24 weeks of gestation is a risk for prolonged hyperglycemia in extremely low-birth weight infants Takeru Yamauchi1,2 Masatoshi Imamura2 Kei Takasawa1 Keisuke Nakajima1,3 Ryuichi Nakagawa1 Maki Gau1 Manabu Sugie2 Atsuko Taki1 Masahiko Kawai4 Kenichi Kashimada 1 Tomohiro Morio1 ●
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Received: 19 January 2020 / Accepted: 18 June 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Hyperglycemia in extremely low-birth weight infants (ELBWIs) is frequently observed during the acute perinatal phase, (i.e., first 1–2 weeks postnatal period); however it can occasionally persists for >2 weeks, extending to the post-acute phase. Since such prolonged hyperglycemia (PH) is not typical for ELBWIs, the aim of the present study was to further understand the clinical details of PH. Twenty-five hyperglycemic ELBWIs born before 28 weeks of gestation from 2015 to 2018 were included in the study. Based on the duration of hyperglycemia, we separated the subjects into two groups: non-prolonged hyperglycemia (NPH) who achieved remission within ≤2 weeks [n = 18, median 3.0 (range, 2.0–4.0) days], and PH, whose hyperglycemia persisted for >2 weeks [n = 7, median 50.0 (range, 33.5–66.0) days]. Compared to the NPH group, glucose metabolism of the PH group was more deteriorate. The peak blood glucose level was significantly higher in the PH group [PH: median 472 mg/dL, NPH: median 275 mg/dL, p < 0.001], and a higher proportion of subjects in the PH group required insulin therapy [PH: 100% (7/7) vs. NPH: 22% (4/22)]. Multivariate analysis revealed that among perinatal factors, prematurity was the only independent risk factor for PH (glucocorticoid therapy: p = 0.884, gestational age: p = 0.006), with a cutoff of 23W4D determined by receiver operating characteristic analysis. Our data revealed distinctive clinical features of PH, suggesting a type different from the previously reported hyperglycemia in ELBWIs. Specifically, extreme prematurity, less than 24 weeks of gestation, is a risk for PH, and aggressive interventions, such as insulin would be required. Keywords Hyperglycemia Extremely low-birth weight infant Insulin therapy Prematurity Glucocorticoid therapy ●
Introduction Hyperglycemia is one of a common clinical problems among extremely low-birth weight infants (ELBWIs) during
Supplementary information The online version of this article (https:// doi.org/10.1007/s12020-020-02393-3) contains supplementary material, which is available to authorized users. * Kenichi Kashimada [email protected] 1
Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
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Department of Neonatology, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
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Department of Pediatrics, Kashiwa Municipal Hospital, Chiba, Japan
4
Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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the perinatal period [1, 2]. Hyperglycemia among ELBWIs
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