Article re-printed with permission from Arkansas Children's Hospital
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Arkansas Childrens Hospital Physicians
Pioneer Use of Insulin Pump for Diabetic Newborn
(Little Rock, Arkansas – August 3, 2000) -- Physicians at Arkansas Children's Hospital are using an insulin pump to control diabetes in a 10-day-old boy, believed to be the youngest-ever to utilize the device.
Born July 22, 2000, Maverick Colt Roe was diagnosed with neonatal diabetes after his blood glucose levels soared to extreme levels within his first few hours of life. Due to limited diet and inactivity, newborns typically register low blood sugar readings. Maverick's levels, however, spiked above 1,000 milligrams per deciliter – more than 10 times the normal range.
Doctors initially treated Maverick with intravenous insulin and then insulin injections, but his blood glucose levels continued to fluctuate wildly, sinking as low as 20 and soaring beyond the meter's register. ACH has had good results using insulin pumps on toddlers whose glucose was difficult to maintain, according to pediatric endocrinologist Dr. Paul Frindik, so the decision was made to try the technology with Maverick. Experts believe it is the first use of an insulin pump in such a young infant. After just two days, the insulin pump has stabilized Maverick's blood glucose level to around 128.
Neonatal diabetes occurs when immature pancreas cells are unable to produce the insulin that's necessary for delivering nutrients throughout the body. It is a rare condition with only three cases treated in 30 years at Arkansas Children's Hospital, according to Dr. Robert Arrington, medical director of the hospital's neonatal intensive care unit where Maverick is being treated. Worldwide, the German Diabetes Journal reports there are fewer than 100 cases of diabetes recorded immediately after birth.
Until recently, it was uncommon to use insulin pumps in children with diabetes, according to Rae Lynn Johnson, a registered nurse and certified diabetes educator at ACH. "Arkansas Children's is one of the few places that will prescribe the pump for small children," Johnson says. "But it makes their glucose so much easier to control, especially when the family is as supportive as Maverick's. The child can lead a much more normal lifestyle without constant injections."
The pump delivers fast-acting insulin every hour through a plastic catheter inserted in the fatty level of skin in Maverick's leg. A tube connects the catheter to the pump, which resembles an electronic beeper and can be clipped to the baby's clothing. Maverick's parents, Bryan and Bridget Roe of Arkadelphia, will continue to track their son's blood glucose levels throughout the day and can boost his dose of insulin as needed – after eating, for example -- simply by pressing the button on a small remote device.
The pump's controls can be locked, so neither Maverick nor his 21-month-old brother can inadvertently change the dosage, which is one fear that prevents many doctors from prescribing the pump for young children.
"We've just not found that to be true for our patients," Johnson says. "Children have the greatest respect for their disease and understand the equipment is not a toy. We've seen that children usually respond better to the pump than to injections."
Doctors also hesitate to use the pump for children until they are old enough to do the necessary calculations for their insulin doses. Because the pump administers a constant dosage, however, it is easier for parents to know when the child will need an insulin boost and can simply push a button to deliver it instead of having to inject each dosage manually.
If Maverick continues to do well on the pump, he could make his first trip home on Friday. As he grows, it is possible that his pancreas will begin producing insulin on its own and he'll no longer need the pump to control his blood glucose levels.