Development of blood glucose control for extremely premature infants

Abstract Extremely premature neonates often experience hyperglycaemia, which has been linked to increased mortality and worsened outcomes. Insulin therapy can assist in controlling blood glucose levels and promoting needed growth. This study presents the development of a model-based stochastic targe...

Full description

Saved in:
Bibliographic Details
Published in:Computer methods and programs in biomedicine 2011-05, Vol.102 (2), p.181-191
Main Authors: Le Compte, Aaron J, Chase, J. Geoffrey, Lynn, Adrienne, Hann, Chris E, Shaw, Geoffrey M, Lin, Jessica
Format: Article
Language:English
Subjects:
Blood Glucose - metabolism
Clinical Protocols
Computer Simulation
Control
Drug Therapy, Computer-Assisted - methods
Glucose
Humans
Hyperglycemia - blood
Hyperglycemia - drug therapy
Infant, Newborn
Infant, Premature - blood
Insulin
Insulin - administration & dosage
Insulin Infusion Systems - statistics & numerical data
Internal Medicine
Models, Biological
Neonate
Other
Pilot Projects
Real-time
Retrospective Studies
Simulation
Stochastic Processes
User interface
User-Computer Interface
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Abstract Extremely premature neonates often experience hyperglycaemia, which has been linked to increased mortality and worsened outcomes. Insulin therapy can assist in controlling blood glucose levels and promoting needed growth. This study presents the development of a model-based stochastic targeted controller designed to adapt insulin infusion rates to match the unique and changing metabolic state and control parameters of the neonate. Long-term usage of targeted BG control requires successfully forecasting variations in neonatal metabolic state, accounting for differences in clinical practices between units, and demonstrating robustness to errors that can occur in everyday clinical usage. Simulation studies were used to evaluate controller ability to target several common BG ranges and evaluate controller sensitivity to missed BG measurements and delays in control interventions on a virtual patient cohort of 25 infants developed from retrospective data. Initial clinical pilot trials indicated model performance matched expected performance from simulations. Stochastic targeted glucose control developed using validated patient-specific virtual trials can yield effective protocols for this cohort. Long-term trials show fundamental success, however clinical interface design appears as a critical factor to ensuring good compliance and thus good control.
ISSN:0169-2607
1872-7565
DOI:10.1016/j.cmpb.2010.03.010