TY - JOUR
T1 - Higher C-peptide levels and glucose requirements may identify neonates with transient hyperinsulinism hypoglycemia who will benefit from diazoxide treatment
AU - Davidov, Anita Schachter
AU - Elkon-Tamir, Erella
AU - Haham, Alon
AU - Shefer, Gabi
AU - Weintrob, Naomi
AU - Oren, Asaf
AU - Lebenthal, Yael
AU - Mandel, Dror
AU - Eyal, Ori
N1 - Publisher Copyright:
© 2019, Springer-Verlag GmbH Germany, part of Springer Nature.
PY - 2020/4/1
Y1 - 2020/4/1
N2 - The aim of the study was to characterize factors that may serve as clinical tools to identify neonates with transient neonatal hyperinsulinism hypoglycemia (HH) who may benefit from diazoxide treatment. This retrospective study included 141 neonates with transient HH (93 males) of whom 34 (24%) were treated with diazoxide. Diazoxide treatment was started at median age of 13 days (range 5–35) and discontinued at median age of 42 days (range 14–224). The maximal dose was 7.1 ± 2.3 mg/kg/day. Diazoxide-treated neonates required a higher glucose infusion rate (GIR) compared with non-treated neonates (16.6 ± 3.4 vs. 10.4 ± 4.0 mg/kg/min, respectively, P <.01), had a longer duration of intravenous fluids (15.9 ± 9.3 vs. 7.8 ± 6.5 days, P <.01), a longer hospitalization (32.8 ± 22.7 vs. 20.4 ± 13.4 days, P <.01), a longer duration of carbohydrate supplementation (38.9 ± 40.4 vs. 17.8 ± 21.4 days, P <.01), and higher mean C-peptide levels on “critical sample” (1.4 ± 0.9 vs. 0.8 ± 0.5 ng/ml, P <.01). Their insulin levels also tended to be higher (3.5 ± 2.9 vs. 2.2 ± 3.8 μU/ml, P =.07). A stepwise logistic regression model revealed that significant predictors of prolonged HH were maximal GIRs (odds ratio (OR) 1.56, 95%; confidence interval (CI) 1.3–1.88, P <.001) and C-peptide levels (OR 3.57, 95%; CI 1.3–12.1, P =.005). Conclusion: Higher C-peptide levels and higher GIR requirements may serve as clinical tools to identify neonates with transient HH who may benefit from diazoxide treatment.What is Known:• Neonates with transient hyperinsulinism usually do not require treatment beyond glucose supplementation due to its self-limited clinical course, but some may benefit from diazoxide treatment.What is New:• Higher C-peptide levels and higher GIR requirements may serve as clinical tools to identify neonates with transient HH who may benefit from diazoxide treatment.• The incidence of prolonged neonatal HH is higher than the currently accepted figures.
AB - The aim of the study was to characterize factors that may serve as clinical tools to identify neonates with transient neonatal hyperinsulinism hypoglycemia (HH) who may benefit from diazoxide treatment. This retrospective study included 141 neonates with transient HH (93 males) of whom 34 (24%) were treated with diazoxide. Diazoxide treatment was started at median age of 13 days (range 5–35) and discontinued at median age of 42 days (range 14–224). The maximal dose was 7.1 ± 2.3 mg/kg/day. Diazoxide-treated neonates required a higher glucose infusion rate (GIR) compared with non-treated neonates (16.6 ± 3.4 vs. 10.4 ± 4.0 mg/kg/min, respectively, P <.01), had a longer duration of intravenous fluids (15.9 ± 9.3 vs. 7.8 ± 6.5 days, P <.01), a longer hospitalization (32.8 ± 22.7 vs. 20.4 ± 13.4 days, P <.01), a longer duration of carbohydrate supplementation (38.9 ± 40.4 vs. 17.8 ± 21.4 days, P <.01), and higher mean C-peptide levels on “critical sample” (1.4 ± 0.9 vs. 0.8 ± 0.5 ng/ml, P <.01). Their insulin levels also tended to be higher (3.5 ± 2.9 vs. 2.2 ± 3.8 μU/ml, P =.07). A stepwise logistic regression model revealed that significant predictors of prolonged HH were maximal GIRs (odds ratio (OR) 1.56, 95%; confidence interval (CI) 1.3–1.88, P <.001) and C-peptide levels (OR 3.57, 95%; CI 1.3–12.1, P =.005). Conclusion: Higher C-peptide levels and higher GIR requirements may serve as clinical tools to identify neonates with transient HH who may benefit from diazoxide treatment.What is Known:• Neonates with transient hyperinsulinism usually do not require treatment beyond glucose supplementation due to its self-limited clinical course, but some may benefit from diazoxide treatment.What is New:• Higher C-peptide levels and higher GIR requirements may serve as clinical tools to identify neonates with transient HH who may benefit from diazoxide treatment.• The incidence of prolonged neonatal HH is higher than the currently accepted figures.
KW - Diazoxide therapy
KW - Neonate
KW - Transient hyperinsulinism hypoglycemia
UR - http://www.scopus.com/inward/record.url?scp=85077022813&partnerID=8YFLogxK
U2 - 10.1007/s00431-019-03544-z
DO - 10.1007/s00431-019-03544-z
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C2 - 31863303
AN - SCOPUS:85077022813
SN - 0340-6199
VL - 179
SP - 597
EP - 602
JO - European Journal of Pediatrics
JF - European Journal of Pediatrics
IS - 4
ER -
