Objective: Studies in adult intensive care have highlighted the importance of insulin and improved glucose control on survival. Very low birth weight (VLBW, birth weight <1500 g) infants requiring intensive care often also have hyperglycaemia during the first week of life. Hyperglycaemia at this time is associated with increased morbidity and mortality. This study aimed to investigate the effect of early intervention with insulin replacement and improved glucose control on mortality and morbidity.
Methods: An international multicentre randomised controlled trial of early insulin replacement in VLBW babies. Infants were randomly assigned (n = 389) to receive a continuous insulin infusion (0.05 units/kg per hour) with 20% dextrose support or standard neonatal care from the first 7 days of life.
Results: Infants in the early intervention arm had lower mean daily glucose level (6.2 vs 6.7 mmol/l, p = 0.007) and fewer babies had hyperglycaemia for >10% of the first week (21.5% vs 33.5%, p = 0.008). They had significant increased non-protein calorie intake 58.1 (1.0) versus 50.3 (0.8) kcal/kg per litre, p<0.000 and reduction in weight loss in the first week (−0.55 (0.52) vs −0.70 (0.47) p = 0.006). However, there was no reduction in mortality by expected date of delivery. Secondary endpoints including episodes of sepsis, necrotising entercolitis, severity of retinopathy, intracranial haemorrhage, chronic lung disease, days of intensive care and growth at 28 days also showed no significant difference between the two arms of the study.
Conclusions: Prophylactic use of early intravenous insulin alone in VLBW infants does not reduce mortality by expected date of delivery.