Neonatal hyperglycemia in a preterm infant managed with a subcutaneous insulin pump

Successful use of a subcutaneous insulin pump to administer regular insulin to a preterm infant with neonatal hyperglycemia is described. A 520-g female infant born at 23 weeks' gestational age via caesarian section was noted to have elevated blood glucose concentrations ranging up to 180 mg/dL (in SI units, 10 mmol/L) on day of life (DOL) 3 and peaking on DOL 9 at 250 mg/dL (13.9 mmol/L) despite conservative glucose infusion rates. Continuous infusion of regular insulin was begun on DOL 8 and continued through DOL 44, with an average insulin infusion rate of 0.08 units/kg/h. The patient experienced blood glucose concentration lability due to multiple factors, resulting in the need for frequent and routine blood glucose concentration monitoring to minimize hypoglycemia events. On DOL 44, a subcutaneous insulin pump was placed and used to provide diluted regular insulin (25 units/mL). After 1 week, the patient's blood glucose concentration normalized, which led to a reduction in the frequency of glucose monitoring. After 3 weeks, insulin pump use was discontinued. The patient remained euglycemic thereafter. The use of an insulin pump resulted in decreased blood glucose checks, discontinuation of central line access, and overall better patient care.