Total parenteral nutrition–associated hyperglycemia correlates with prolonged mechanical ventilation and hospital stay in septic infants

PurposeWe studied the effects of total parenteral nutrition (TPN)–associated hyperglycemia on the clinical outcome in premature septic infants in the neonatal intensive care unit.MethodsThe charts of all premature infants weighing less than 1500 g upon admission to the neonatal intensive care unit between January 1, 2002, and December 31, 2002, with sepsis, ventilator dependence, and feeding intolerance were studied. Maximum serum glucose concentrations were compared with duration of TPN, mechanical ventilation, hospital length of stay, and survival using Pearson regression analysis and Student's t test.ResultsThirty-seven patients met the search criteria. The average caloric intake for all infants at the time of blood culture–proven sepsis was 83 ± 19 kcal/kg per day. The maximum serum glucose concentration (milligrams per deciliter) after having positive blood cultures (sepsis) was positively correlated with the duration of TPN (r = 0.45, P = .005), length of dependence on mechanical ventilation (r = 0.45, P = .006), and hospital length of stay (r = 0.36, P = .03). The average maximum serum glucose level was significantly higher in the nonsurviving infants (241 ± 46 vs 141 ± 48, P < .0001).ConclusionHyperglycemia correlated with prolonged ventilator dependency and increased hospital length of stay in premature septic infants. Avoidance of excessive nutrient delivery and tight glycemic control during periods of acute metabolic stress may improve outcome in this patient population.