Hyperinsulinemia After Extensive Small Bowel Resection and Total Parenteral Nutrition in a Neonate: A Case Study

Neonatal hyperinsulinemia is a rare condition, but poses a significant increase in the risk of recurrent and persistent hypoglycemia in newborns, which can lead to long-term neurodevelopmental complications if not identified early. This condition may be due to a congenital disorder, or arise transiently due to perinatal stress, and may develop as a consequence of interventions such as total parenteral nutrition (TPN). Infants diagnosed with SBO following extensive intestinal resection are particularly at higher risk.

This report is of a 2-week-old male neonate, delivered at 36 weeks gestation with a birth weight of 2.5 kg, the patient presented with jaundice, bilious emesis, and poor weight gain. Surgical intervention showed a midgut volvulus with extensive ischemic necrosis. A near-total resection of the small intestine performed. As a result, the patient developed short bowel syndrome as a result and required total parenteral nutrition (TPN). Even with administration of high-dose intravenous glucose (up to 13 mg/kg/min), the patient continued to experience recurrent, persistent hypoglycemia. Elevated insulin levels alongside normal cortisol, ACTH, growth hormone, and ammonia are revealed by laboratory evaluation, the profile suggest a stress-induced hyperinsulinemia. Management included careful glucose monitoring, optimization of TPN, and initiation of pharmacotherapy including diazoxide with hydrochlorothiazide. This approach led to stabilization of blood glucose and gradual transition to partial enteral feeding.

This case highlights the complexity of diagnosing and managing hyperinsulinemia in neonates with short bowel syndrome who totally depend on TPN. Persistent hypoglycemia despite high glucose infusions should raise the concern of hyperinsulinism. Early identification is important. A multidisciplinary team approach is required to avoid serious complications.