A 1000 g neonate develops persistent hyperglycaemia, glycosuria, and osmotic diuresis on day 2 of total parenteral nutrition. The specialist registrar decides to restrict glucose content in total parenteral nutrition (TPN). However, the consultant disagrees and decides to start a continuous insulin infusion while administering full TPN to control blood glucose and achieve weight gain. Is the consultant’s decision based on sound evidence?

Structured clinical question

In hyperglycaemic very low birth weight (VLBW) neonates on parenteral nutrition [patient] does addition of insulin therapy without glucose restriction [intervention] improve glycaemic control and weight gain [outcome]?

Search strategy and outcome

Primary search: the Cochrane Library (2005, issue 2). Search term [hyperglycemia AND insulin]. Search results: 560 controlled trials in CENTRAL of which two were relevant and 19 were reviews that were not relevant.

Secondary search: Pubmed and Medline 1966–2005, Embase 1974–2005, Cinahl 1982–2005 using Dialog DataStar. Search term [hyperglycemia AND insulin]. Filter clinical queries. Limit to newborn, human and English language. Search results: Pubmed (17), Medline (19), Embase (75) and Cinahl (1) of which two were controlled trials (already retrieved by Cochrane) and four were case series.

See table 3.

Commentary

Hyperglycaemia occurs commonly in preterm neonates admitted to intensive care, with a reported incidence of 40–80% among VLBW (1000–1500 g) neonates.^7–9 Hyperglycaemia …