Abstract
Background Small-for-gestational-age (SGA) infants are at-risk of hyperinsulinemic hypoglycemia (HH), requiring high glucose infusion rates (GIR) to maintain euglycemia.
Objectives To compare the outcomes of SGA infants treated with diazoxide (DZX) versus watchful waiting (WW) with high GIR and feeds in the management of HH.
Methods This observational study was conducted from September 2014 to September 2020. SGA infants with HH (GIR >10 mg/kg/min, plasma glucose level < 3.0 mmol/l with detectable insulin) were identified. Data on sex, gestational age (GA), birth weight (BW), age at presentation, symptoms, critical investigations, GIR, dose and duration of DZX treatment, and outcomes were analyzed.
Results 56 SGA infants were identified – 27 DZX and 29 WW, male infants being 56% and 62% respectively. Mean GA were 36.4(31–40) for DZX and 36(30–39) weeks for WW. BW were 1942±356 vs 1873±498 gm respectively. 96.4% of infants presented on day 1 of life. More DZX treated infants had symptomatic HH (DZX, 22% vs WW, 7%; p=0.227). Paired glucose/insulin levels were 2.37±0.47 mmol/L/16.39±27.4 mU/L in DZX and 2.45±0.65 mmol/L/8.65±11.3 mU/L in WW cohort (p=0.196). Maximum GIR in DZX cohort was 14.8±4.3 vs 13.1±3.2 mg/kg/min in WW (p=0.097). Mean day of DZX initiation was 12.9±8.2 days with an average treatment duration of 65 days and the maximum dose was 4.6±2.2 mg/kg/day. Duration of central venous line, day of resolution, and day to discharge were not statistically different between the two cohorts. However, infants who had DZX initiation <10d vs >10d of life had earlier resolution of HH (p=0.013).
Conclusions Spontaneous resolution does occur in SGA infants with high GIR and feeds. DZX being a KATPchannel agonist, its use should be restricted to symptomatic infants requiring persistently high GIR, especially in early days of life, as the DZX related long-term outcome is unclear. Duration of intensive care treatment for HH was not statistically different between the two cohorts.
