January 27, 2009

Intensive Insulin Therapy Reduces Mortality in Sick Kids

TUESDAY, Jan. 27 (HealthDay News) -- Intensive insulin therapy may reduce the risk of death, infection and the length of intensive care stays for seriously ill children, a European study suggests.

Abnormally high blood sugar (hyperglycemia) often occurs in critically ill infants and children, and increases their risk of secondary infections and death.

This study included 700 critically ill patients -- 317 infants under 1 and 383 children aged 1 to 16 years. They were randomly assigned to receive either intensive insulin treatment to reduce their blood glucose level to its normal level or to receive insulin treatment only if their blood glucose level reached dangerously high levels (conventional therapy).

Mean blood glucose concentrations were lower among those who received the intensive therapy than among those who received conventional therapy. More children in the intensive therapy group developed hypoglycemia (abnormally low blood sugar), but they had a lower death rate (3 percent vs. 6 percent) and a shorter intensive care stay (5.5 days vs. 6.1 days) than those in the conventional therapy group.

The findings were expected to be published in an upcoming issue of The Lancet.

"Targeting of blood glucose concentrations to age-adjusted normal fasting concentrations improved short-term outcome of patients in pediatric intensive care units. The effect on long-term survival, morbidity, and neurocognitive development needs to be investigated," Dr. Greet Van den Berghe, of University Hospital Gasthuisberg and Catholic University Leuven, Belgium, and colleagues wrote in a journal news release.

More research into this type of treatment is needed, Dr. Mitchell M. Levy, of Brown University and Rhode Island Hospital, and Dr. Andrew Rhodes, of St. George's Healthcare NHS Trust in the United Kingdom, wrote in an accompanying commentary.

"Clinicians must take into account several factors, including the nature of the intensive-care population in their institution and the incidence of hypoglycemia with local insulin protocols when determining what glucose target is most appropriate for their critically ill patients. Perhaps the results of ongoing large-scale trials will provide greater clarity for this clinical dilemma," Levy and Rhodes wrote.

More information

The Nemours Foundation offers information for parents of children in the ICU.

-- Robert Preidt
SOURCE: The Lancet, news release, Jan. 27, 2009
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