Background: Hyperinsulinism hypoglycemia in infants is characterized by inappropriate insulin secretion from pancreatic beta-cells. Prompt recognition and treatment, are essential to decrease risk of neurologic damage. Neonates with transient hyperinsulinism usually do not require treatment due to its self-limited clinical course. However, some may benefit from diazoxide treatment which inhibits insulin secretion.
Objectives: To identify perinatal factors associated with transient neonatal hyperinsulinemia in diazoxide-treated as compared to untreated neonates.
Patients & methods: Retrospective chart review of 141 neonates (93 males) with transient hyperinsulinism born in our hospital between 01/01/2015 and 30/04/2018.
Results: Thirty-four (24%) were diazoxide-treated, mean gestational age (36 ± 2.7 weeks) and birth weight (2.175 ± 0.699 Kg). Diazoxide-treated and untreated groups were similar in both perinatal (gestational age, birth weight, apgar score) and maternal factors (age, number of pregnancies, deliveries, diabetes, hypertension, eclampsia). Diazoxide treatment was started on day 14.6 (95CI, 11.8-17.4) and discontinued on day 49 (95CI, 34.4-63.9); maximal dose was 7.1 mg/kg/day (95CI, 6.3-7.9). Diazoxide-treated neonates required higher glucose infusion rate (16.6 vs 10.4 mg/kg/min, p<0.01), longer duration of IV fluids (15.9 vs 7.8 days, p<0.01), longer hospitalization (32.8 vs 20.4 days, p<0.01) and longer duration of carbohydrate supplementation (32.8 vs 20.4 days, p<0.01). Mean C-peptide levels were higher (1.4 vs. 0.8 ng/ml, p<0.01) and mean insulin levels tended to be higher (3.5 vs 2.2 mcU/ml, p=0.07) in diazoxide-treated neonates. Summary: Higher C-peptide levels and glucose requirements may serve as a clinical tool to determine whether or not to initiate diazoxide treatment in transient hyperinsulinism.
