Treatment of Severe Hyperglycemia in Extremely Preterm Infants Using Continuous Subcutaneous Insulin Therapy.

Background: Hyperglycemia in preterm infants is usually treated with adjustment of glucose intake and, if persistent, with continuous insulin infusion. However, hypoglycemia is a well-known complication of iv insulin treatment. The aim of our study was to evaluate the feasibility of continuous subcutaneous insulin infusion (CSII) in extremely preterm infants. Methods and material: Clinical data from 15 extemely premature infants (< 28 weeks of gestation) undergoing CSII treatment for severe hyperglycemia at the NICU were included. Blood glucose levels during CSII as well as the nutritional intake and insulin intake were sampled. Data were analyzed and compared to a control group of very preterm infants receiving iv insulin therapy. Results: Normoglycemia rates were best in the iv insulin-cohort (50.3%; 15.6%). Hypoglycemia was very rare in both groups (0.4%; 0.0%). CSII therapy might require higher insulin doses compared to continuous iv therapy. Discussion: Subcutaneous Insulin therapy in extremely preterm infants is feasible, regarding the prevention of hypoglycemia. However, dose control needs to be improved. Conclusion: The results justify further model validation and clinical trial research to explore a model-based protocol and the use of CSII.

[Gait analysis in cerebral palsy patients--correlations between disorders of muscle coordination and gait abnormalities]. / Ganganalyse beim Cerebralparetiker--Beziehungen zwischen Störungen der Muskelkoordination und Ganganomalien.

Electromyographic and gait investigations of 35 patients and 32 healthy persons were evaluated in order to get hints upon the origin of anomalous movements of the pelvis and the spine with following results: a. The amount of the spine motions of CP-patients is significantly greater than that of health persons. The motions of the pelvis of the patients also seems to be greater, but there is no significance. b. The average electromyographical activity of the hip abductors of CP-patients is not remarkably diminished, that of the hip adductors is not increased. We also found no signs of an atrophy of the hip adductors or a hypertrophy of the hip adductors. c. There is no correlation between the disturbances of coordination of the entire lower leg measured by electromyography and the amount of the pathologic motions. d. We found a distinct correlation between the disturbances especially of the hip ab- and adductors and the amount of the pathologic motions. This amount is the smaller, the worse is the coordination of these two groups of muscles. The topics a-c do not allow to find the origin of the Duchenne- and Trendelenburg limpings of CP-patients, topic d also gives explanation of this fact. In opposition we may suppose here that the bad timing of the coordination resp. the corresponding permanent electrical activity of the hip ab- and adductors has a stabilizing influence upon the pelvis and the spine. As the most probable origin of the increased Duchenne limping we not suppose the increased motions of the stance phase. Our following investigations will deal with this hypothesis.