Neonatal hyperglycemia in a preterm infant managed with a subcutaneous insulin pump

Abstract

Purpose: Successful use of a subcutaneous insulin pump to administer regular insulin to a preterm infant with neonatal hyperglycemia is described.

Summary: A 520-g female infant born at 23 weeks' gestational age via caesarian section was noted to have elevated blood glucose concentrations ranging up to 180 mg/dL (in SI units, 10 mmol/L) on day of life (DOL) 3 and peaking on DOL 9 at 250 mg/dL (13.9 mmol/L) despite conservative glucose infusion rates. Continuous infusion of regular insulin was begun on DOL 8 and continued through DOL 44, with an average insulin infusion rate of 0.08 units/kg/h. The patient experienced blood glucose concentration lability due to multiple factors, resulting in the need for frequent and routine blood glucose concentration monitoring to minimize hypoglycemia events. On DOL 44, a subcutaneous insulin pump was placed and used to provide diluted regular insulin (25 units/mL). After 1 week, the patient's blood glucose concentration normalized, which led to a reduction in the frequency of glucose monitoring. After 3 weeks, insulin pump use was discontinued. The patient remained euglycemic thereafter.

Conclusion: The use of an insulin pump resulted in decreased blood glucose checks, discontinuation of central line access, and overall better patient care.

Keywords: diluted regular insulin; extremely low-birthweight neonate; neonatal hyperglycemia; subcutaneous insulin pump.