Performance and Safety of STAR Glycaemic Control in Neonatal Intensive Care: Further Clinical Results Including Pilot Results from a New Protocol Implementation

Abstract Elevated blood glucose concentrations (BG) (Hyperglycaemia) are a common complication of prematurity in extremely low birth weight neonates in the neonatal intensive care unit (NICU), and are associated with increased mortality and morbidity. Insulin therapy allows glucose tolerance and weight gain to be increased. However, insulin therapy is commonly associated with a significant increase in low BG events (hypoglycaemia), which is also associated with adverse outcomes. Controlling BG levels via nutrition restriction reduces infant growth and is thus undesirable. STAR (Stochastic TARgeted) is a model-based glycaemic framework that mitigates the risks of hypoglycaemia through quantification of current insulin sensitivity and future variability. From August 2008 to December 2012 40 patients totaling 61 glycaemic episodes were treated with STAR in the NICU (STAR-NICU). Percentage time in the clinically targeted 4.0-8.0 mmol/L band was 62%, a 14% increase compared to retrospective data and hyperglycaemia (BG>10.0mmol/L) was halved. Overall incidence of severe hypoglycemia (BG