Role of Insulin in Enhancing Growth with Parenteral Nutrition

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Exogenous insulin is most commonly used to control early hyperglycemia in very preterm infants. However, informal surveys suggest that there are a number of centers that use insulin in preterm neonates receiving parenteral nutrition for the purpose of enhancing growth. Insulin has been shown to successfully lower glucose levels and to increase weight gain without undue risk of hypoglycemia [23-25]. It is presumed that improved weight gain is secondary to both increased glucose utilization and improved protein balance in infants receiving parenteral nutrition. However, little is known about the effects of intravenous insulin infusions and relative hyperinsulinemia on the quality of weight gain and on counterregulatory hormone concentrations and the possible effects of these concentrations.

Administration of intravenous amino acids has been shown to decrease glucose concentrations in ELBW infants, presumably by enhancing endogenous insulin secretion. In the above study by Thureen et al. [20], an approximate doubling of insulin concentration occurred in the high versus low amino acid intake study group. The much lower incidence of neonatal hyper-glycemia following the earlier postnatal introduction of parenteral amino acids was reported by Micheli et al. [26], and may be due to increased insulin secretion. It is known that enteral feeding also stimulates insulin release in infants. Since instituting a policy of early 'high-dose' parenteral amino acids, glucose intake rates at a maximum of 12 mg/kg/min and early minimal enteral feeding (MEF), we have virtually no significant hyperglycemia in preterm neonates, and insulin use is rare in our nurseries.

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