Presented at the Neonatal Society 2014 Spring Meeting.
Green J, Burgess L, Morgan C
Liverpool Women’s Hospital, Liverpool, UK
Background: We have shown that hyperalimentation using a Standardised, Concentrated, Added Macronutrients Parenteral (SCAMP) nutrition regimen improves early head growth (1). Hyperglycaemia is a major barrier to hyperalimentation strategies in very preterm infants (VPI). Insulin-treated hyperglycaemia (ITH) avoids the need to reduce glucose (and energy) intake, although evidence for benefit is limited. Early postnatal growth is associated with increased potassium/phosphate supplementation (2) and lower plasma amino acids (AA). We hypothesised that VPI with ITH would achieve optimal growth with hyperalimentation and have associated changes in metabolic markers.
Methods: SCAMP and control groups were identified from the previously published RCT (1) (ISRCTN 76597892; funded by Bliss). Infants were substratified into ITH and non-ITH within their original group randomisation. Hyperglycaemia necessitating insulin treatment required two consecutive blood glucose measurements >12mmol/l. Actual mean daily protein/energy intake and weekly growth (occipitofrontal head circumference; OFC; weight) were primary outcome measures. Secondary metabolic outcome data included mean daily blood glucose, daily electrolyte intake (including supplementary electrolytes), daily plasma electrolyte and weekly plasma AA data.
Results: Protein/energy intake and growth data (change in (Δ) OFC/weight between randomisation and day 28) are summarised in Table 1. SCAMP ITH infants required higher rates of potassium (p<0.001) and phosphate (p<0.001) supplementation than SCAMP non-ITH infants. There was no difference between ITH and non-ITH infants in the control group. Plasma AA levels (17/23 of the individual AA measured) were lower in SCAMP ITH versus non-ITH infants. By contrast, 5/23 individual AA plasma levels were lower in control ITH versus non-ITH.
Conclusion: ITH only associated with optimal growth when combined with hyperalimentation. This is also associated with increased potassium/phosphate supplementation and lower plasma AA in the first 14 days of life.
Corresponding author: Colin.morgan@lwh.nhs.uk
References
1. Morgan C, McGowan P, Herwitker S et al. Pediatrics 2014;133:e620-8.
2. Bonsante F, Iacobelli S, Chantegret C, Martin D, Gouyon JB. Eur J Clin Nutr. 2011;65:1088-93.