Experience with enteral sulfonylurea monotherapy for extremely low birth weight infants with hyperglycemia

Abstract

Limited data are available on the effects of enteral sulfonylurea (SU) monotherapy in extremely low birth weight infants (ELBWIs) with hyperglycemia. Therefore, we report our experience with enteral SU monotherapy for hyperglycemic ELBWIs. We retrospectively evaluated 11 hyperglycemic ELBWIs (seven male infants, median gestational age = 24.9 wk) who received SU between January 2016 and December 2019. Blood glucose (BG) levels were monitored before and after SU initiation and evaluated for the occurrence of adverse effects. We administered SU at a median of 15 d (interquartile range [IQR]: 12-20 d) after birth, with the median maximum dose of 0.2 mg/kg/d (IQR: 0.125-0.3 mg/kg/d). Hyperglycemia improved in all patients, and the target BG levels were achieved without severe side effects at a median of 6 d (IQR: 4-8.5 d) after initiation of treatment. The incidence of hypoglycemia during SU treatment was observed in 18 events per 1000 patient hours; however, the patients were asymptomatic. Based on these results, enteral SU monotherapy may be considered as an option for hyperglycemic ELBWIs.

Keywords: extremely low birth weight; glyburide (glibenclamide); hyperglycemia; infant; sulfonylurea.

Fig. 1.

Patient flow chart.

Fig. 2.

Daily blood glucose levels for 14 d before and after the introduction of sulfonylurea (SU). Cases 1 and 4 patients received intravenous insulin before SU treatment. The blood glucose (BG) levels decreased within a few days after SU administration in all patients. Cases 5, 6, and 9 patients required reintroduction of SU because their BG levels were elevated after SU discontinuation. Hypoglycemic events during SU treatment occurred in six patients, all of whom were asymptomatic.