Dextrose with Insulin During Neonatal Resuscitation for Prolonged Asphyxia in a Near-Term Ovine Model

Background : Neonatal myocytes rely predominantly on glycolytic metabolism for survival during hypoxic conditions. During asphyxia, metabolic pathway dysregulation impairs cardiac myocyte contractility. Co-administration of dextrose and insulin may help restore metabolic homeostasis and improve cardiac function. Methods : Following blinded randomization and instrumentation, near-term lambs (138-140 days gestational age) were asphyxiated by umbilical cord occlusion until complete cardiac arrest, followed by 7 min of continued arrest to model severe asphyxia. Return of spontaneous circulation (ROSC) was defined as heart rate ≥ 100 beats per minute (bpm) and diastolic blood pressure ≥ 20 mmHg. Results : The incidence of ROSC was 3/6 in the control group compared to 5/5 in the experimental group receiving dextrose-insulin therapy, although this difference did not reach statistical significance. Conclusions : In this proof-of-concept study using a near-term ovine model of prolonged asphyxial cardiac arrest, dextrose and insulin co-administered with epinephrine were associated with improved ROSC rates although could be an association. Larger studies are needed to confirm these findings and evaluate clinical translation

Asphyxia · Blood pressure · Cardiac output · Heart rate · Insulin · Resuscitation · Return of spontaneous circulation · Cardiac Arrest and Resuscitation · Neonatal and fetal brain pathology · Neonatal Respiratory Health Research