Background: In newborns, physiological transition of glucose metabolism is typically completed within 4872 h of life, yet prolonged hyperinsulinemic hypoglycemia (HH) beyond 5d of life is not uncommonly encountered, especially in infants at-risk of hypoglycemia. Management includes intravenous dextrose while awaiting spontaneous resolution (SR) of HH or Diazoxide (DZX) therapy. Since DZX acts by suppressing insulin release, concerns arise whether weight gain in infancy will be suppressed.
Aim: To compare weight change patterns in infants with prolonged HH managed with dextrose infusion awaiting SR and those who received DZX treatment.
Methods: HH was diagnosed in infants >48 h of life needing GIR >8 mg/kg per min to maintain blood glucose (BG) >3.4 mmol/l, who had hypoketonemia and inappropriate insulin levels with BG <3 mmol/l. These infants also failed to achieve full oral feeds after 5d of life without hypoglycemia. Data on demographics, birth weight, gestational age, treatment modality and duration, and follow-up body weight were collected. Resolution of HH in SR infants was confirmed by normal home glucose for 2 weeks following discharge and DZX infants passed fasting studies on completion of treatment. Birth weight z-scores were determined using Fenton 2013 tables and follow-up body weight z-scores were derived from WHO 2006 standards. Changes in weight z-score were analyzed.
Results: 46 infants met the inclusion criteria. The SR group included 22 (13 male, 9 preterm) with birth weight 2647±927g (SDS −0.56±1.50) at GA 36.2w; and follow-up weight 4539±1545g (SDS −0.83±1.19) at corrected age (CA) 3.8 m. The DZX group included 24 (16 male, 11 preterm) with birth weight 2133±626 g (SDS −1.36±1.02) at GA 36.8w; and follow-up weight 4673±1707g (SDS −1.5±1.11) at CA 3m. Median length of stay was 16d (741d) and 18d (1050d) in SR and DZX babies, respectively. Median DZX dose was 3 mg/kg per day (312 mg) and duration of treatment was 56d. There was no difference in weight SDS change (−0.27 vs −0.13, P=0.69) between SR and DZX treated infants. In a sub-analysis of SGA infants, no weight change difference between 11 SR and 16 DZX infants (0.00 vs 0.29, P=0.36) was observed.
Conclusion: In this cohort of HH infants, the use of DZX therapy did not suppress weight gain and resulted in weight gain patterns similar to those of SR infants.
27 - 29 Sep 2018
European Society for Paediatric Endocrinology