Relationship between Insulin-Like Growth Factor I Levels, Early Insulin Treatment, and Clinical Outcomes of Very Low Birth Weight Infants

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• 作者：Kathryn Beardsall ; FRCPCH¹ ; ² ; ^{kb274@cam.ac.uk" class="auth_mail} ; Sophie Vanhaesebrouck ; PhD³ ; Jan Frystyk ; MD ; PhD ; DMSc⁴ ; Amanda L. Ogilvy-Stuart ; FRCP² ; Christine Vanhole ; PhD³ ; Mirjam van Weissenbruch ; PhD⁵ ; Paula Midgley ; FRCPCH⁶ ; Marta Thio ; MD⁷ ; Luc Cornette ; MD⁸ ; Bryan Gill ; FRCPCH⁸ ; Iviano Ossuetta ; FRCPCH⁹ ; Isabel Iglesias ; MD⁷ ; Claire Theyskens ; MD¹⁰ ; Miranda de Jong ; MD⁵ ; Jag S. Ahluwalia ; FRCPCH² ; Francis de Zegher ; PhD³ ; David B. Dunger ; MD ; FMed Sci¹ ; on behalf of the NIRTURE Study Group &lowast
• 关键词：CGM ; Continuous glucose monitor ; CLD ; Chronic lung disease ; IGF-I ; Insulin-like growth factor I ; NEC ; Necrotizing enterocolitis ; NIRTURE ; Neonatal Insulin Replacement Therapy in Europe ; ROP ; Retinopathy of prematurity ; VLBW ; Very low birth weight
• 刊名：The Journal of Pediatrics
• 出版年：May, 2014
• 年：2014
• 卷：164
• 期：5
• 页码：1038-1044.e1
• 全文大小：233 K

文摘

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Objectives

Insulin regulates the secretion of insulin-like growth factor I (IGF-I) in the newborn, and low levels of IGF-I have been linked to neonatal morbidity. As part of the Neonatal Insulin Replacement Therapy in Europe Trial, we investigated the impact of early insulin treatment on IGF-I levels and their relationship with morbidity and growth.

Study design

Prospective cohort analyses of data collected as part of an international randomized controlled trial. Blood samples (days 1, 3, 7, and 28), were taken for IGF-I bioassay from 283 very low birth weight infants (<1500聽g).

Results

Early insulin treatment led to a late increase in IGF-I levels between day 7 and 28 (P聽=聽.028). In the first week of life IGF-I levels were lower in infants with early hyperglycemia; mean difference 鈭?.10聽渭g/L (95% CI 鈭?.19, 鈭?.02, P聽=聽.02). Lower levels of IGF-I at day 28 were independently associated with an increased risk of chronic lung disease, OR 3.23 (95% CI, 1.09-9.10), and greater IGF-I levels were independently associated with better weight gain, 0.10聽kg (95% CI, 0.03-0.33, P聽=聽.02).

Conclusions

Early intervention with insulin is related to increased IGF-I levels at 28聽days. Low IGF-I levels are associated with hyperglycemia, increased morbidity, and reduced growth. Increasing IGF-I levels may improve outcomes of very low birth weight infants.