Are recurrent hyperglycemic episodes and median blood glucose level a prognostic factor for increased morbidity and mortality in premature infants ≤ 1500 g?

Background: Tight blood glucose control with intravenous insulin reduces morbidity and mortality in adult surgical intensive care patients. This has never been investigated in premature infants weighing <= 1500 g. We investigate the relationship between blood glucose levels repeatedly elevated > 150 mg/dL and median blood glucose levels in the first week of life on one hand, and morbidity and mortality in premature infants weighing <= 1500 g on the other. Patients and methods: The following data were collected from 252 premature infants weighing <= 1500 g at birth: demographic data, blood glucose levels at three set times during the day (capillary and arterial) in the first week of life, actual and relative elevation of blood glucose level 150 mg/dL, median blood glucose level, allocation of patients into groups according to number of elevated blood glucose levels > 150 mg/dL (0, 1-3 or > 4 incidents), and median blood sugar level in relation to mortality and morbidity like IVH, ROP, and sepsis. Results: A significant increase in mortality (P < 0.0001) with increasing median blood glucose level and repeated ( 4) incidents of blood glucose levels 150 mg/dL and in infants with low gestational age (< 27 weeks) were observed. There was no correlation between blood glucose level and morbidity. Conclusion: Premature infants with low gestational age (< 27 weeks), elevated median blood glucose levels and/or repeatedly elevated blood glucose levels >= 150 mg/dL have a significantly increased mortality. However, further prospective studies considering the gestational age should determine the relationship between tight glucose control and mortality.