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Licensed Unlicensed Requires Authentication Published by De Gruyter December 10, 2021

Hyperinsulinemic hypoglycemia in growth restricted convalescent preterm neonates: clinical characteristics and impediments to early diagnosis

Megan Rodrigues, Pratibha Rana, Gene Lee, Chaitali Mahajan, Michael Nyp and Vishal Pandey



Describe clinical characteristics, course, and risk factors for hyper-insulinemic hypoglycemia (HIH) in preterm infants and identify impediments to early diagnosis.


Electronic records of infant–mother dyads were used to describe clinical characteristics, lab parameters, and course of HIH.


All eight patients (gestational ages 26w0d–29w3d) had intrauterine growth restriction (IUGR) due to placental insufficiency, (4/8) were small for gestational age. All maintained normal glucose levels with glucose infusion during the first 48 h six of eight patients had cholestasis despite being on parenteral nutrition for short time (average 17 days). Four of eight patients were treated with diazoxide (average 22 days). Four of eight patients who recovered spontaneously (average 49 days after diagnosis) responded to continuous feeds and hydrocortisone for other clinical indications.


In IUGR preterms, HIH is asymptomatic, may be prolonged, requiring diazoxide treatment. Transient cholestasis is seen in majority of patients. Euglycemia should be demonstrated on bolus gavage feeds, off glucocorticoids before discontinuing blood glucose monitoring.

Corresponding author: Vishal Pandey, MD, University of Kansas, School of Medicine, Kansas City, KS, USA; and Division of Neonatology, Children’s Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 64108, USA, Phone: +1 216 315 5882, E-mail:

  1. Research funding: No outside funding was received for this project.

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission. All authors participated in the retrieval of the data and take responsibility for its integrity and accuracy. Retrieval and interpretation of maternal data: GL, MR. Concept and design: VP, CM and MN. Analysis, interpretation, and display of the data: all authors. Initial draft of the paper: VP. Critical revision of the paper: VP, CM, MN. Intellectual content: all authors. Supervision: VP.

  3. Competing interests: Authors state no conflict of interest. The authors declare that they have no competing interests. The view(s) expressed herein are those of the author(s) and do not reflect the official policy or position of University of Kansas Medical Center, Children’s Mercy Hospital.

  4. Informed consent: Informed consent was obtained from all individuals included in this study.

  5. Ethical approval: The University of Kansas Medical center’s Institutional Review Board approved the study prior to obtaining the data.


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Received: 2021-08-18
Accepted: 2021-11-18
Published Online: 2021-12-10
Published in Print: 2022-03-28

© 2021 Walter de Gruyter GmbH, Berlin/Boston

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