Early Insulin Doesn't Help Very Low-Birth-Weight Infants

Aggressive use of phototherapy may be helpful

WEDNESDAY, Oct. 29 (HealthDay News) -- Early use of insulin does not improve the outcome for very low-birth-weight infants, but aggressive use of phototherapy significantly improves the rate of neurodevelopmental impairment, although the risks of this treatment outweigh the benefits in very low-birth-weight-infants, according to two studies published in the Oct. 30 issue of The New England Journal of Medicine.

Kathryn Beardsall of the University of Cambridge in the United Kingdom and colleagues conducted a trial of 195 infants randomized to receive insulin and 194 randomized to receive standard neonatal care for the first seven days of life. They found that while insulin treatment can reduce hyperglycemia, it may increase hypoglycemia and offers little clinical benefit.

Brenda H. Morris, M.D., of the University of Texas Medical School in Houston and colleagues assigned 1,974 infants at 12 to 36 hours of age to receive either aggressive or conservative phototherapy. They found that the therapy reduced neurodevelopmental impairment in very low-birth-weight babies, but among infants weighing 501 to 750 grams at birth, the gains may be offset by increased mortality.

"Aggressive phototherapy may be preferred for infants with birth weights of 751 to 1,000 g, because we found significant neurodevelopmental benefits in this subgroup and no evidence that the therapy increased the rate of death or other adverse outcomes at 18 to 22 months," the authors write.

The first study was supported by Novo Nordisk and Medtronic. Authors of the first study report financial relationships with the pharmaceutical industry, including Novo Nordisk. The authors of the second study report financial relationships with Natus Medical, which provided support for the study.

Abstract: Beardsall et al
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Abstract: Morris et al
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