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Observational Study
. 2023 Jun 14:14:1163591.
doi: 10.3389/fendo.2023.1163591. eCollection 2023.

Watchful waiting versus pharmacological management of small-for-gestational-age infants with hyperinsulinemic hypoglycemia

Suresh Chandran  1   2   3   4 , Sandra Lynn Jaya-Bodestyne  1 , Victor Samuel Rajadurai  1   2   3   4 , Seyed Ehsan Saffari  5 , Mei Chien Chua  1   2   3   4 , Fabian Yap  2   3   4   6
Affiliations
Observational Study

Watchful waiting versus pharmacological management of small-for-gestational-age infants with hyperinsulinemic hypoglycemia

Suresh Chandran et al. Front Endocrinol (Lausanne). .

Abstract

Introduction: Given that reports on severe diazoxide (DZX) toxicity are increasing, we aimed to understand if the short-term clinical outcomes of small-for-gestational-age (SGA) infants with hyperinsulinemic hypoglycemia (HH) managed primarily by supportive care, termed watchful waiting (WW), are different from those treated with DZX.

Method: A real-life observational cohort study was conducted from 1 September 2014 to 30 September 2020. The WW or DZX management decision was based on clinical and biochemical criteria. We compared central line duration (CLD), postnatal length of stay (LOS), and total intervention days (TIDs) among SGA-HH infants treated with DZX versus those on a WW approach. Fasting studies determined the resolution of HH.

Result: Among 71,836 live births, 11,493 were SGA, and 51 SGA infants had HH. There were 26 and 25 SGA-HH infants in the DZX and WW groups, respectively. Clinical and biochemical parameters were similar between groups. The median day of DZX initiation was day 10 of life (range 4-32), at a median dose of 4 mg/kg/day (range 3-10). All infants underwent fasting studies. Median CLD [DZX, 15 days (6-27) vs. WW, 14 days (5-31), P = 0.582] and postnatal LOS [DZX, 23 days (11-49) vs. WW, 22 days (8-61), P = 0.915] were comparable. Median TID was >3-fold longer in the DZX than the WW group [62.5 days (9-198) vs. 16 days (6-27), P < 0.001].

Conclusion: CLD and LOS are comparable between WW and DZX groups. Since fasting studies determine the resolution of HH, physicians should be aware that clinical intervention of DZX-treated SGA-HH patients extends beyond the initial LOS.

Keywords: diazoxide; fasting study; hyperinsulinemic hypoglycemia; small-for-gestational-age; watchful waiting.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
The flow diagram of participants included in the study. DZX, diazoxide; HH, hyperinsulinemic hypoglycemia; FCP; feed-centric pathway; GCP, glucose-centric pathway; RFS, resolution fasting study; SGA, small-for-gestational-age; WW, watchful waiting.
Figure 2
Figure 2
Vertical timeline of SGA infants diagnosed with HH during the study period, managed with DZX (n = 26, open ο circles) and WW (n = 25, bold • circles). The respective incidence of SGA-HH during the glucose-centric pathway (GCP) and the feed-centric pathway (FCP) period is shown. DZX, diazoxide; HH, hyperinsulinemic hypoglycemia; SGA, small-for-gestational-age; WW, watchful waiting.
See this image and copyright information in PMC

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