pilot study of a model-based approach to blood glucose control in very-low-birthweight neonates试点研究基于模型的方法在一)新生儿血糖控制.pdfVIP

Le Compte et al. BMC Pediatrics 2012, 12:117 /1471-2431/12/117 RESEARCH ARTICLE Open Access Pilot study of a model-based approach to blood glucose control in very-low-birthweight neonates 1* 2 3 1 4 Aaron J Le Compte , Adrienne M Lynn , Jessica Lin , Christopher G Pretty , Geoffrey M Shaw and J Geoffrey Chase1 Abstract Background: Hyperglycemia often occurs in premature, very low birthweight infants (VLBW) due to immaturity of endogenous regulatory systems and the stress of their condition. Hyperglycemia in neonates has been linked to increased morbidities and mortality and occurs at increasing rates with decreasing birthweight. In this cohort, the emerging use of insulin to manage hyperglycemia has carried a significant risk of hypoglycemia. The efficacy of blood glucose control using a computer metabolic system model to determine insulin infusion rates was assessed in very-low-birth-weight infants. Methods: Initial short-term 24-hour trials were performed on 8 VLBW infants with hyperglycemia followed by long- term trials of several days performed on 22 infants. Median birthweight was 745 g and 760 g for short-term and long-term trial infants, and median gestational age at birth was 25.6 and 25.4 weeks respectively. Blood glucose control is compared to 21 retrospective patients from the same unit who received insulin infusions determined by sliding scales and clinician intuition. This study was approved by the Upper South A Regional Ethics Committee, New Zealand (ClinicalT registration NC. Results: Reduction in hyperglycemia towards the target glucose band was achieved safely in all cases during the short-term trials with no hypoglycemic episodes. Lower median blood glucose concentratio