Hyperglycemia Associated With Complications in Septic Neonates

PHOENIX — Critically ill infants on total parenteral nutrition may face more complications and worse outcomes as a result of hyperglycemia induced by overfeeding, reported Diya I. Alaedeen, M.D., at the annual meeting of the American Pediatric Surgical Association.

A retrospective review of 37 premature infants treated for sepsis during a 1-year period found associations between hyperglycemia, morbidity, and mortality. The higher their maximum serum glucose concentration, the longer the babies were on mechanical ventilation and the longer they stayed in the hospital, Dr. Alaedeen said.

The average maximum glucose level was 100 mg/dL higher in 6 babies (16%) who died than in 31 babies who lived. It reached 241 mg/dL in nonsurvivors vs. 141 mg/dL in survivors.

“Avoiding caloric overfeeding, perhaps with tight glycemic control, in critically ill infants might be effective for reducing hyperglycemia-associated morbidity and mortality,” said Dr. Alaedeen of Rainbow Babies and Children's Hospital in Cleveland.

Dr. Alaedeen and his colleagues reviewed all ventilator-dependent premature infants who weighed less than 1,500 g, had culture-proven sepsis, and required total parenteral nutrition while treated in the hospital's neonatal intensive care unit during 2002. Coagulase-negative staphylococci were the most common cause of sepsis, identified in 76% of cases.

Among survivors, 20 infants had maximum glucose levels above 120 mg/dL; their average length of stay exceeded 100 days. The other 11 survivors had levels at or below 120 mg/dL and stayed a little more than 60 days on average.

The study found that the average caloric intake for all infants was 83 ±19 kcal/kg per day during the first week after sepsis was proved by culture. This intake exceeds the average measured energy expenditure of 40–60 kcal/kg per day observed in infants during states of acute metabolic stress, according to Dr. Alaedeen.

“It is likely that our babies were overfed. When [infants] are ill, they are not using these calories to grow,” he added in an interview.

Dr. Alaedeen noted that the project could not discern to what degree hyperglycemia was a result of overfeeding by total parenteral nutrition as distinguished from a response to injury. To resolve that issue, he called for a prospective study “correlating C-reactive protein, as a measure of acute metabolic stress, and/or MEE [measured energy expenditure] with caloric delivery.”

Moderator Daniel H. Teitelbaum, M.D., of the University of Michigan in Ann Arbor, praised the presentation as “a wonderful study.” He noted that it echoes correlations in an influential paper associating hyperglycemia with worse outcomes in critically ill adults (N. Engl. J. Med. 2001; 345:1359–67).

PHOENIX — Critically ill infants on total parenteral nutrition may face more complications and worse outcomes as a result of hyperglycemia induced by overfeeding, reported Diya I. Alaedeen, M.D., at the annual meeting of the American Pediatric Surgical Association.

A retrospective review of 37 premature infants treated for sepsis during a 1-year period found associations between hyperglycemia, morbidity, and mortality. The higher their maximum serum glucose concentration, the longer the babies were on mechanical ventilation and the longer they stayed in the hospital, Dr. Alaedeen said.

The average maximum glucose level was 100 mg/dL higher in 6 babies (16%) who died than in 31 babies who lived. It reached 241 mg/dL in nonsurvivors vs. 141 mg/dL in survivors.

“Avoiding caloric overfeeding, perhaps with tight glycemic control, in critically ill infants might be effective for reducing hyperglycemia-associated morbidity and mortality,” said Dr. Alaedeen of Rainbow Babies and Children's Hospital in Cleveland.

Dr. Alaedeen and his colleagues reviewed all ventilator-dependent premature infants who weighed less than 1,500 g, had culture-proven sepsis, and required total parenteral nutrition while treated in the hospital's neonatal intensive care unit during 2002. Coagulase-negative staphylococci were the most common cause of sepsis, identified in 76% of cases.

Among survivors, 20 infants had maximum glucose levels above 120 mg/dL; their average length of stay exceeded 100 days. The other 11 survivors had levels at or below 120 mg/dL and stayed a little more than 60 days on average.

The study found that the average caloric intake for all infants was 83 ±19 kcal/kg per day during the first week after sepsis was proved by culture. This intake exceeds the average measured energy expenditure of 40–60 kcal/kg per day observed in infants during states of acute metabolic stress, according to Dr. Alaedeen.

“It is likely that our babies were overfed. When [infants] are ill, they are not using these calories to grow,” he added in an interview.

Dr. Alaedeen noted that the project could not discern to what degree hyperglycemia was a result of overfeeding by total parenteral nutrition as distinguished from a response to injury. To resolve that issue, he called for a prospective study “correlating C-reactive protein, as a measure of acute metabolic stress, and/or MEE [measured energy expenditure] with caloric delivery.”

Moderator Daniel H. Teitelbaum, M.D., of the University of Michigan in Ann Arbor, praised the presentation as “a wonderful study.” He noted that it echoes correlations in an influential paper associating hyperglycemia with worse outcomes in critically ill adults (N. Engl. J. Med. 2001; 345:1359–67).

PHOENIX — Critically ill infants on total parenteral nutrition may face more complications and worse outcomes as a result of hyperglycemia induced by overfeeding, reported Diya I. Alaedeen, M.D., at the annual meeting of the American Pediatric Surgical Association.

A retrospective review of 37 premature infants treated for sepsis during a 1-year period found associations between hyperglycemia, morbidity, and mortality. The higher their maximum serum glucose concentration, the longer the babies were on mechanical ventilation and the longer they stayed in the hospital, Dr. Alaedeen said.

The average maximum glucose level was 100 mg/dL higher in 6 babies (16%) who died than in 31 babies who lived. It reached 241 mg/dL in nonsurvivors vs. 141 mg/dL in survivors.

“Avoiding caloric overfeeding, perhaps with tight glycemic control, in critically ill infants might be effective for reducing hyperglycemia-associated morbidity and mortality,” said Dr. Alaedeen of Rainbow Babies and Children's Hospital in Cleveland.

Dr. Alaedeen and his colleagues reviewed all ventilator-dependent premature infants who weighed less than 1,500 g, had culture-proven sepsis, and required total parenteral nutrition while treated in the hospital's neonatal intensive care unit during 2002. Coagulase-negative staphylococci were the most common cause of sepsis, identified in 76% of cases.

Among survivors, 20 infants had maximum glucose levels above 120 mg/dL; their average length of stay exceeded 100 days. The other 11 survivors had levels at or below 120 mg/dL and stayed a little more than 60 days on average.

The study found that the average caloric intake for all infants was 83 ±19 kcal/kg per day during the first week after sepsis was proved by culture. This intake exceeds the average measured energy expenditure of 40–60 kcal/kg per day observed in infants during states of acute metabolic stress, according to Dr. Alaedeen.

“It is likely that our babies were overfed. When [infants] are ill, they are not using these calories to grow,” he added in an interview.

Dr. Alaedeen noted that the project could not discern to what degree hyperglycemia was a result of overfeeding by total parenteral nutrition as distinguished from a response to injury. To resolve that issue, he called for a prospective study “correlating C-reactive protein, as a measure of acute metabolic stress, and/or MEE [measured energy expenditure] with caloric delivery.”

Moderator Daniel H. Teitelbaum, M.D., of the University of Michigan in Ann Arbor, praised the presentation as “a wonderful study.” He noted that it echoes correlations in an influential paper associating hyperglycemia with worse outcomes in critically ill adults (N. Engl. J. Med. 2001; 345:1359–67).