ESPE Abstracts

Background: Transient hyperinsulinism (THI) is a hypoglycemia disorder manifesting during the first days of life and usually resolving within the first weeks or months of life. Neonates exposed to pre- or perinatal stress have a higher risk to develop THI. However, the exact pathomechanism has not been elucidated yet. The objective of this study was to analyze the clinical and biochemical data of neonates with THI and a birth weight <1500 g.

Methods: The electronic patient data base of the University Hospital Düsseldorf was searched for children born between 01/2013 and 12/2021 with a birth weight <1500 g and <1000 g (very low/extremely low birth weight; VLBW/ELBW) and a diagnosis of THI.

Results: Sixteen neonates (5 female) were identified. Median gestational age was 27+2 weeks (range: 24+0-33+6) and median birth weight was 970 g (range: 490-1470 g). 5/16 were small for gestational age (birth weight <10^th percentile). Median age at first registered hypoglycemia ≤45 mg/dl (age >3 hours of life) was 27 days (range: 6-52 days) and occurred in 13 neonates at a median of 16 days after cessation of regular parenteral nutrition. All neonates received carbohydrate-enriched meals to treat hypoglycemia. In addition, 6 neonates received intravenous (i.v.) glucose plus diazoxide, 3 received i.v. glucose plus subcutaneous (s.c.) glucagon, 4 were either treated with i.v. glucose, s.c. glucagon, diazoxide or octreotide. Two neonates were stabilized on carbohydrate-enriched meals. Mean maximum total glucose intake was 25 g/kg/d (range: 20.1-29.8 g/kg/d). In 14 infants THI resolved before first hospital discharge at a median age of 98 days (range: 29-147 days). Two infants were discharged home with diazoxide.

Conclusion: In comparison to term born or late preterm neonates, who usually have an onset of THI on the first day of life, VLBW and ELBW neonates show a distinctly delayed onset of THI. Severity varies widely ranging from mild forms requiring only carbohydrate-enriched meals to severe forms requiring intense medical treatment and high glucose intake. Interestingly, the manifestation of THI accompanies clinical stabilization and, in most cases, is not directly time-related to the cessation of parenteral nutrition. The pathomechanism of the delayed onset remains to be clarified. It might be possible that postnatal/extrauterine stress caused by prematurity and associated problems such as ventilation, infections, etc. lead to a predisposition to THI, as seen in term or late preterm born neonates in association with prenatal/intrauterine stress.