Dextrose with Insulin During Neonatal Resuscitation for Prolonged Asphyxia in a Near-Term Ovine Model: A Proof-of-Concept Study

<b>Background</b>: 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. <b>Methods</b>: 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. <b>Results</b>: 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. <b>Conclusions</b>: 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.