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[Neonatal hypoglycemia caused by hyperinsulinism and subsequent epilepsy]
Insights
Neonatal hypoglycemia from insulin excess can increase epilepsy risk, particularly when seizures are prolonged and severe. Early diagnosis and management are crucial for affected newborns.
Area of Science:
- Pediatric Neurology
- Neonatology
- Endocrinology
Context:
- Neonatal hypoglycemia, particularly due to insulin excess, presents a significant clinical challenge.
- Understanding the long-term neurological sequelae, such as epilepsy, is crucial for affected infants.
Purpose:
- To investigate the epilepsy risk in newborns experiencing hypoglycemia secondary to insulin excess.
Summary:
- A cohort study followed 18 newborns with insulin-induced neonatal hypoglycemia.
- Only one infant with severe, persistent hypoglycemia and seizures developed epilepsy.
- Asymptomatic or less severe hypoglycemia did not elevate epilepsy risk.
Impact:
- Identifies severe and prolonged neonatal hypoglycemia as a risk factor for developing epilepsy.
- Highlights the importance of considering the duration and severity of hypoglycemia in prognostic assessments.
- Informs clinical management and follow-up strategies for infants with neonatal hypoglycemia.
Abstract:
A historical cohort study was undertaken to determine the risk of epilepsy in a population of 18 newborns with neonatal hypoglycemia due to insulin excess. Follow-up was 3 years 8 months (range 7 years-1 year 3 months). Insulin excess was associated with maternal diabetes in 13 infants, with an isolated macrosomia in 2 infants, in one case with probable Langerhans hyperplasia, and in 2 newborns only prolonged beta-sympathomimetic therapy was the possible cause of insulin excess. Newborns with anoxia, brain malformation or small for date were excluded. Two newborns had hypoglycemia with epileptic clonic seizures, but only one was later epileptic. In this case, hypoglycemia was severe and persistent (16 hours). Hyperinsulinism was related to Langerhans hyperplasia. CT scan made at ages one and 6 months showed large hypodensity of the frontal and occipital white matter. Visual evoked responses were also abnormal. Visual evoked responses and CT scan normalized at 1 year. In other children, asymptomatic hypoglycemia (n = 11) or symptomatic hypoglycemia without epileptic seizures (n = 5) did not increase the epileptic risk as none of them had epileptic seizure later on. Thus, seizures associated with neonatal hypoglycemia alone seem to increase the epileptic risk with duration and severity of hypoglycemia being also essential prognostic factors.