title: Relationship between insulin-like growth factor I levels, early insulin treatment, and clinical outcomes of very low birth weight infants.
abstract: OBJECTIVE
  Insulin regulates the secretion of insulin-like growth factor I (IGF-I) in the newborn, and low levels of IGF-I have been linked to neonatal morbidity. As part of the Neonatal Insulin Replacement Therapy in Europe Trial, we investigated the impact of early insulin treatment on IGF-I levels and their relationship with morbidity and growth.
  
  
  METHODS
  Prospective cohort analyses of data collected as part of an international randomized controlled trial. Blood samples (days 1, 3, 7, and 28), were taken for IGF-I bioassay from 283 very low birth weight infants (<1500 g).
  
  
  RESULTS
  Early insulin treatment led to a late increase in IGF-I levels between day 7 and 28 (P = .028). In the first week of life IGF-I levels were lower in infants with early hyperglycemia; mean difference -0.10 μg/L (95% CI -0.19, -0.02, P = .02). Lower levels of IGF-I at day 28 were independently associated with an increased risk of chronic lung disease, OR 3.23 (95% CI, 1.09-9.10), and greater IGF-I levels were independently associated with better weight gain, 0.10 kg (95% CI, 0.03-0.33, P = .02).
  
  
  CONCLUSIONS
  Early intervention with insulin is related to increased IGF-I levels at 28 days. Low IGF-I levels are associated with hyperglycemia, increased morbidity, and reduced growth. Increasing IGF-I levels may improve outcomes of very low birth weight infants.
authors: Department of Pediatrics, University of Cambridge, Addenbrooke's Hospital NHS Trust, Hills Road, Cambridge, United Kingdom; Neonatal Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom. Electronic address: kb274@cam.ac.uk.
authors: Kathryn
authors: K
authors: Beardsall
authors: Department of Woman and Child, University of Leuven, Leuven, Belgium.
authors: Sophie
authors: S
authors: Vanhaesebrouck
authors: Medical Research Laboratory, Department of Clinical Medicine, Faculty of Health, Aarhus University and Department of Internal Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark.
authors: Jan
authors: J
authors: Frystyk
authors: Neonatal Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.
authors: Amanda L
authors: AL
authors: Ogilvy-Stuart
authors: Department of Woman and Child, University of Leuven, Leuven, Belgium.
authors: Christine
authors: C
authors: Vanhole
authors: VU University Medical Center, Amsterdam, The Netherlands.
authors: Mirjam
authors: M
authors: van Weissenbruch
authors: Simpson Center for Reproductive Health, Royal Infirmary of Edinburgh, Edinburgh, Scotland.
authors: Paula
authors: P
authors: Midgley
authors: Hospital Universitari Sant Joan de Déu, Esplugues, Barcelona, Spain.
authors: Marta
authors: M
authors: Thio
authors: Leeds General Infirmary, Leeds, United Kingdom.
authors: Luc
authors: L
authors: Cornette
authors: Leeds General Infirmary, Leeds, United Kingdom.
authors: Bryan
authors: B
authors: Gill
authors: Luton and Dunstable Hospital, Bedfordshire, United Kingdom.
authors: Iviano
authors: I
authors: Ossuetta
authors: Hospital Universitari Sant Joan de Déu, Esplugues, Barcelona, Spain.
authors: Isabel
authors: I
authors: Iglesias
authors: ZOL Genk, Genk, Belgium.
authors: Claire
authors: C
authors: Theyskens
authors: VU University Medical Center, Amsterdam, The Netherlands.
authors: Miranda
authors: M
authors: de Jong
authors: Neonatal Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.
authors: Jag S
authors: JS
authors: Ahluwalia
authors: Department of Woman and Child, University of Leuven, Leuven, Belgium.
authors: Francis
authors: F
authors: de Zegher
authors: Department of Pediatrics, University of Cambridge, Addenbrooke's Hospital NHS Trust, Hills Road, Cambridge, United Kingdom.
authors: David B
authors: DB
authors: Dunger
mesh_terms: D015415:Biomarkers / Q000378:metabolism; D001786:Blood Glucose / Q000378:metabolism; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000097:blood / Q000517:prevention & control*; D019102:Infant, Very Low Birth Weight / Q000097:blood*; D007328:Insulin / Q000627:therapeutic use*; D007334:Insulin-Like Growth Factor I / Q000378:metabolism*; D057194:Intention to Treat Analysis; D016014:Linear Models; D008173:Lung Diseases, Obstructive / Q000097:blood / Q000209:etiology / Q000517:prevention & control; D008297:Male; D011446:Prospective Studies; D016896:Treatment Outcome; D015430:Weight Gain
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin; D007334:Insulin-Like Growth Factor I