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Insulin, light treatment therapies may not help preemies

By Nicole Ostrow
Bloomberg News / October 30, 2008
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NEW YORK - Two treatments intended to improve the health of premature babies didn't help their survival rate, according to research in the New England Journal of Medicine.

Insulin injections given to control high blood sugar levels failed to boost survival in very premature infants, a European study found. A second study found that light therapy, which treats ailments by using special lamps, didn't improve the survival rate of these premature babies with jaundice.

Each week in the United States, more than 10,000 babies are born prematurely, or before completing the 37th week of pregnancy, according to the March of Dimes, the White Plains, New York-based charity. Of these babies, an average of 1,200 a week have a birth weight of less than 3.3 pounds. These smallest babies have a higher risk of respiratory problems, neurological maladies, and dying from complications like infections.

The findings indicate doctors shouldn't give low-birth-weight babies insulin routinely, Richard Polin, a professor at Columbia University and doctor at Morgan Stanley Children's Hospital of New York-Presbyterian, said in an interview.

"We would not routinely use insulin," said Polin, who wrote an accompanying editorial in the journal. "This study is not convincing that routine insulin is beneficial." Insulin is the main hormone in the body that regulates blood sugar.

Low-birth-weight babies don't produce enough insulin, and the insulin they do produce may be compromised by infection, drugs, and other stresses from birth, David Dunger, a study author and professor at England's University of Cambridge, said in an e-mail. A lack of insulin, which is important to growth, may be associated with poor weight gain, he said.

Researchers studied 195 infants who received a continuous infusion of insulin and 194 babies who were given standard care. During their first week of life, 28 infants in the insulin group died, compared with 18 in the standard-care group.

Insulin didn't lower an infant's risk of dying and was associated with an increased risk for low blood sugar, Dunger said.

"The results were disappointing," he said. "Any beneficial effects may have been canceled out by the increased risk of low sugars. I still believe insulin therapy does have a place, and we need to work hard to optimize delivery."

A second study in found that light therapy didn't improve the survival rate of very-low-weight babies with jaundice.

Jaundice is a yellowing of the skin caused by the buildup of a potentially toxic chemical. If untreated in babies, it could cause brain injury leading to cerebral palsy, developmental disabilities, blindness, and hearing loss.

From September 2002 to April 2005, researchers studied 1,974 babies born weighing 1.1 pounds to 2.2 pounds. The babies received either early light therapy or standard treatment, which also included light therapy later.

The researchers found that infants in the early treatment group were less likely to have neurological problems than those in the standard care group. Babies weighing 1.1 pounds to 1.65 pounds had a somewhat higher risk of dying with the early therapy than those on standard care, the authors wrote.

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