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Management of Neonatal Hyperinsulinemic Hypoglycemia: Trends Over Nine Years

Sabitha Sasidharan Pillai1, Meghan E Fredette1, Joshua Ray Tanzer2

  • 1Division of Pediatric Endocrinology, Hasbro Children's Hospital, The Warren Alpert Medical School of Brown University, Providence, RI.

Rhode Island Medical Journal (2013)
|December 18, 2024
PubMed

Insights

Diazoxide use for hyperinsulinemic hypoglycemia (HH) has changed, with delayed initiation and reduced use in preterm and small for gestational age (SGA) infants. Pulmonary hypertension (PHT) occurred in 12.5% of treated infants, particularly those born preterm or SGA.

Area of Science:

  • Pediatric Endocrinology
  • Neonatology
  • Pharmacology

Background:

  • Increasing use of diazoxide for hyperinsulinemic hypoglycemia (HH) is associated with a rise in reported serious side effects, notably pulmonary hypertension (PHT).
  • Understanding diazoxide's safety profile is crucial, especially in vulnerable infant populations.

Purpose of the Study:

  • To analyze changes in diazoxide prescribing patterns for infants with HH.
  • To investigate the association between diazoxide use and the development of PHT in infants, with a focus on preterm and small for gestational age (SGA) infants.

Main Methods:

  • Retrospective chart review of infants diagnosed with HH and evaluated by Pediatric Endocrinology.
  • Analysis of diazoxide initiation timing, usage rates, and PHT development, stratified by gestational age and SGA status.

Main Results:

  • Diazoxide initiation was delayed in preterm and SGA infants after June 2017, and in all infants after May 2020.
  • The proportion of SGA infants receiving diazoxide decreased significantly after May 2020.
  • Pulmonary hypertension (PHT) developed in 12.5% of infants treated with diazoxide, with higher incidence in preterm/SGA infants and those born to mothers with preeclampsia.

Conclusions:

  • Diazoxide prescribing patterns for HH have evolved, marked by delayed and reduced use in high-risk infant groups (preterm, SGA).
  • Pulmonary hypertension is a significant concern in infants treated with diazoxide, particularly those born preterm, SGA, or exposed to maternal preeclampsia.
Abstract

Keywords:
Congenital hyperinsulinismdiazoxidehypoglycemianeonatologypulmonary hypertension

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