Background Hyperglycemia (HG) has been reported in up to 70% of extremely low birth weight (ELBW) infants (birth weight < 1,000 g). This condition has been associated with an increased risk of retinopathy of prematurity (ROP), intraventricular hemorrhage (IVH), osmotic diuresis, dehydration, and death.
Objective To describe the incidence of HG in ELBW infants, risk factors, and related morbidities. Design/Methods: Retrospective chart review of live-born ELBW infants admitted to University Hospital, San Antonio, Texas, from 1998-2001. 230 charts were reviewed; 45 were excluded due to previable status. HG was defined as serum glucose level $ 150 mg/dL during the first 2 weeks of life. Logistic regression, multivariate analysis, and Fisher exact test were performed using SPSS and SAS.
Results 185 patients were eligible for the analysis. The mean gestational age (GA) and mean birth weight (BW) were 25.9 6 2.1 weeks and 760 6 138 g, respectively. Seventy-two percent of the infants were Hispanic and 55% were male. The incidence of HG was 88%. The mean serum glucose level for the HG group was 249 mg/dL 6 83 compared to 128 mg/dL 6 16 for the normoglycemic group; both groups peaked on day of life 6 (1-15 d). On average, the number of days with hyperglycemia was 3.7 days. There were no differences in race, gender, prenatal steroid use, sepsis, and chorioamnionitis between the groups. Using a multivariate analysis, higher GA had a protective effect for HG (OR 0.16, CI 0.04-0.53), whereas BW, small for gestational age (SGA), sepsis, and postnatal steroids had no effect. ROP was significantly associated with HG after adjusting for GA, BW, and postnatal steroid use (OR 4.6, CI 1.12-18.9). Laser treatment was required in 15/66 patients with ROP in the HG group, and 0/3 with ROP in the normoglycemic group (p .37). Bronchopulmonary dysplasia (BPD), IVH, length of stay, and death were not associated with HG.
Conclusions In our predominantly Hispanic population, the incidence of HG is higher than previously reported. However, race was not identified as a risk factor. HG infants tend to be more immature by GA at birth, independent of BW and SGA status. HG was associated with the development of ROP even after correction for GA, BW, and postnatal steroid use. This association may be due to an expression of severity of illness, although no differences in death, length of stay, IVH, or BPD were demonstrated. Further studies need to be done to determine if this association is causal.
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