Extreme prematurity factors in prolonged hyperglycaemia

Some extremely low-birth weight (ELBW) infants develop hyperglycaemia, which may persist for more than 2 weeks extending to the post-acute phase among those born extremely premature at <24 weeks of gestation, a study has found.

The analysis involved 25 ELBW infants born before 28 weeks of gestation who developed hyperglycaemia, which resolved within ≤2 weeks in 18 infants (non-prolonged; median, 3.0 days) and persisted for >2 weeks in seven (median, 50.0 days).

Clinical features were more severe in the prolonged vs non-prolonged group. Specifically, the infants with prolonged hyperglycaemia exhibited poorer glucose metabolism, with significantly higher peak blood glucose level (median, 472 vs 275 mg/dL; p<0.001). Additionally, all of them required insulin therapy as opposed to only 22 percent in the non-prolonged group.

In terms of perinatal factors, the median gestational age was significantly earlier among infants in the prolonged group (23 weeks 4 days vs 26 weeks 1 day; p=0.003). Indeed, prematurity emerged as the only independent risk factor for prolonged hyperglycaemia (odds ratio, 5.814, 95 percent confidence interval, −0.037 to −0.004; p=0.016), with a cutoff of 23 weeks and 4 days determined by receiver operating characteristic analysis.

The present data showcase distinctive clinical features of prolonged hyperglycaemia in ELBW infants. This type of event would be expected to have more deleterious effects than the classically described and would require more aggressive therapy such as insulin. As such, blood glucose levels should be repeatedly monitored in the post-acute phase among extremely premature infants born before a gestational age of 24 weeks.