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Does the use of diazoxide for hyperinsulinaemic hypoglycaemia increase the risk of necrotising enterocolitis in neonates?
  1. Gonzalo Solís-García1,2,
  2. Telford Yeung3,
  3. Bonny Jasani2,4
  1. 1Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada
  2. 2Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
  3. 3Neonatology, Windsor Regional Hospital, Windsor, Ontario, Canada
  4. 4The Hospital for Sick Children, Toronto, Ontario, Canada
  1. Correspondence to Dr Gonzalo Solís-García, Neonatology, The Hospital for Sick Children, Toronto, Canada; gonsolisg92{at}gmail.com

https://doi.org/10.1136/archdischild-2023-325726

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    Scenario

    A 334/7 weeks’ gestation male neonate, small for gestational age secondary to placental insufficiency (birth weight 1309 g, second centile) is admitted to the neonatal intensive care unit (NICU) for prematurity and mild respiratory distress syndrome. During the first few days of admission, the patient has severe hypoglycaemia that is not responsive to enteral or intravenous interventions. Despite significant escalation in glucose infusion rate (GIR) up to 18 mcg/kg/min, the infant has ongoing episodes of hypoglycaemia; thus, a glucagon infusion is started on day 2 and increased to a peak dose of 0.02 mg/kg/hour. On day 9, the baby is stable in room air and has been able to be weaned off glucagon, but still requires parenteral nutrition with a high GIR, via a peripherally inserted central line. High insulin levels (60–65 pmol/L) were detected during two different hypoglycaemic episodes, and the rest of the critical labs were normal. Feeds are increased with good tolerance; in order to optimise glucose levels, continuous feeds are initiated and fortification is escalated to 0.85 kcal/mL to increase GIR. Despite these interventions, plasma glucose levels are still between 3.2 mmol/L and 3.3 mmol/L. Paediatric endocrinology was consulted; diazoxide treatment is suggested as an option to wean intravenous GIR and progress to full feeds, but given the baseline risk factors of prematurity and intrauterine growth restriction, the possible risk of necrotising enterocolitis (NEC) is brought up as a possible factor influencing the treatment decision.

    Structured clinical question

    What is the incidence of NEC in neonates treated with diazoxide?

    Search strategy and outcome

    We searched PubMed, Embase, Cochrane CENTRAL, Scopus and CINAHL for studies evaluating use of diazoxide in both term and preterm neonates diagnosed with persistent refractory hypoglycaemia, defined as hypoglycaemia requiring high GIR (GIR >12 mg/kg/min) beyond 72 hours of age, at a postnatal age of <28 days (for term newborns) or <42 weeks’ corrected gestational …

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    Footnotes

    • Twitter @gonsolisg

    • Contributors BJ and TY developed the initial idea of research. GS-G performed the literature search. BJ and GS-G collected and analysed the data, and drafted the manuscript. TY and BJ reviewed the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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