Relationships Between Early Nutrition and Blood Glucose Concentrations in Very Preterm Infants.
J Pediatr Gastroenterol Nutr
; 66(6): 960-966, 2018 Jun.
Article
em En
| MEDLINE
| ID: mdl-29481441
ABSTRACT
OBJECTIVES:
The aim of the study was to determine whether changes to early nutrition are associated with levels of glycemia in very preterm infants.METHODS:
A retrospective, observational study of infants <1500âg or <30 weeks' gestation admitted to Neonatal Intensive Care, National Women's Hospital, New Zealand, before (Old Protocol) and after (New Protocol) a change in nutritional protocol. Nutritional intakes were calculated and averaged by day for postnatal days 1 to 7 (week 1) and 1 to 28 (month 1). Relationships between glycemia measures, macronutrient intakes, and achievement of 10% enteral feeds (≥10% total intake) were explored using logistic regression.RESULTS:
Old Protocol (nâ=â190) and New Protocol (nâ=â267) groups had similar baseline characteristics. In week 1, New Protocol infants received more protein, less fat, and carbohydrate, had lower mean blood glucose concentrations (BGCs) (meanâ±âSD 4.9â±â1.2 vs 5.6â±â1.4âmmoll/L, Pâ<â0.0001), less hyperglycemia (BGCâ>â8.5âmmol/L, 71 [27%] vs 80 [42%], Pâ=â0.0005), but similar hypoglycemia (BGCâ<â2.6). In month 1, New Protocol infants also had less hyperglycemia (105 [39%] vs 96 [51%], Pâ=â0.02) and lower mean BGC (5.0â±â1.1 vs 5.5â±â1.1âmmol/L, Pâ<â0.0001), but insulin usage was similar. After adjustment for birth weight z score and gestational age, hyperglycemia was significantly associated with week 1 intakes (gâ·âkgâ·âday) of protein (odds ratio [95% confidence intervals] 0.47 [0.23-0.79], Pâ=â0.004), fat (0.54 [0.40-0.74], Pâ<â0.0001), and carbohydrate (1.25 [1.09-1.44], Pâ<â0.0001). These relationships were similar for month 1. Each additional day to achieve 10% enteral feeds was associated with increased odds of hypoglycemia (1.09 [1.00-1.18], Pâ=â0.04) and hyperglycemia (1.16 [1.06-1.28], Pâ=â0.002).CONCLUSIONS:
In very preterm infants, macronutrient balance and small, early enteral feeds may assist glycemic control.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Nutrição Parenteral
/
Hiperglicemia
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Hipoglicemia
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Cuidado do Lactente
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Doenças do Prematuro
Tipo de estudo:
Diagnostic_studies
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Guideline
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Female
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Humans
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Male
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Newborn
Idioma:
En
Revista:
J Pediatr Gastroenterol Nutr
Ano de publicação:
2018
Tipo de documento:
Article