Skip to content
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

Abstract

Objectives

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

Methods

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

Results

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.

Conclusions

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.

References

1. Hoe, FM, Thornton, PS, Wanner, LA, Steinkrauss, L, Simmons, RA, Stanley, CA. Clinical features and insulin regulation in infants with a syndrome of prolonged neonatal hyperinsulinism. J Pediatr 2006;148:207–12. https://doi.org/10.1016/j.jpeds.2005.10.002.Search in Google Scholar PubMed

2. Fafoula, O, Alkhayyat, H, Hussain, K. Prolonged hyperinsulinaemic hypoglycaemia in newborns with intrauterine growth retardation. Arch Dis Child Fetal Neonatal Ed 2006;91:F467. https://doi.org/10.1136/adc.2006.095919.Search in Google Scholar PubMed PubMed Central

3. Arya, VB, Flanagan, SE, Kumaran, A, Shield, JP, Ellard, S, Hussain, K, et al.. Clinical and molecular characterisation of hyperinsulinaemic hypoglycaemia in infants born small-for-gestational age. Arch Dis Child Fetal Neonatal Ed 2013;98:F356–8. https://doi.org/10.1136/archdischild-2012-302880.Search in Google Scholar PubMed PubMed Central

4. de Lonlay, P, Fournet, JC, Touati, G, Groos, MS, Martin, D, Sevin, C, et al.. Heterogeneity of persistent hyperinsulinaemic hypoglycaemia. A series of 175 cases. Eur J Pediatr 2002;161:37–48. https://doi.org/10.1007/s004310100847.Search in Google Scholar PubMed

5. Chong, JH, Chandran, S, Agarwal, P, Rajadurai, VS. Delayed presentation of prolonged hyperinsulinaemic hypoglycaemia in a preterm small-for-gestational age neonate. BMJ Case Rep 2013;2013. https://doi.org/10.1136/bcr-2013-200920.Search in Google Scholar PubMed PubMed Central

6. Fournet, JC, Junien, C. The genetics of neonatal hyperinsulinism. Horm Res 2003;59(Suppl 1):30–4. https://doi.org/10.1159/000067842.Search in Google Scholar PubMed

7. Glaser, B, Thornton, P, Otonkoski, T, Junien, C. Genetics of neonatal hyperinsulinism. Arch Dis Child Fetal Neonatal Ed 2000;82:F79–86. https://doi.org/10.1136/fn.82.2.f79.Search in Google Scholar PubMed PubMed Central

8. Levine, TA, Grunau, RE, McAuliffe, FM, Pinnamaneni, R, Foran, A, Alderdice, FA. Early childhood neurodevelopment after intrauterine growth restriction: a systematic review. Pediatrics 2015;135:126–41. https://doi.org/10.1542/peds.2014-1143.Search in Google Scholar PubMed

9. McKinlay, CJD, Alsweiler, JM, Anstice, NS, Burakevych, N, Chakraborty, A, Chase, JG, et al.. Association of neonatal glycemia with neurodevelopmental outcomes at 4.5 years. JAMA Pediatr 2017;171:972–83. https://doi.org/10.1001/jamapediatrics.2017.1579.Search in Google Scholar PubMed PubMed Central

10. Desai, J, Key, L, Swindall, A, Gaston, K, Talati, AJ. The danger of diazoxide in the neonatal intensive care unit. Ther Adv Drug Saf 2021;12:20420986211011338. https://doi.org/10.1177/20420986211011338.Search in Google Scholar PubMed PubMed Central

11. Limesand, SW, Rozance, PJ. Fetal adaptations in insulin secretion result from high catecholamines during placental insufficiency. J Physiol 2017;595:5103–13. https://doi.org/10.1113/jp273324.Search in Google Scholar

12. Baserga, MC, Sola, A. Intrauterine growth restriction impacts tolerance to total parenteral nutrition in extremely low birth weight infants. J Perinatol 2004;24:476–81. https://doi.org/10.1038/sj.jp.7211137.Search in Google Scholar PubMed

13. Thornton, PS, Stanley, CA, De Leon, DD, Harris, D, Haymond, MW, Hussain, K, et al.. Recommendations from the Pediatric Endocrine Society for evaluation and management of persistent hypoglycemia in neonates, infants, and children. J Pediatr 2015;167:238–45. https://doi.org/10.1016/j.jpeds.2015.03.057.Search in Google Scholar PubMed

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

Scroll Up Arrow