SAT-271 Higher C-Peptide Levels and Glucose Requirements May Identify Neonates with Transient Hyperinsulinism Hypoglycemia Who Will Benefit from Diazoxide Treatment

Abstract

Background: Hyperinsulinism hypoglycemia in infants is characterized by inappropriate insulin secretion from pancreatic beta-cells. Prompt recognition and treatment are essential to decrease the risk of neurologic sequelae. Neonates with transient hyperinsulinism usually do not require treatment due to its self-limited clinical course, but some may benefit from diazoxide treatment which inhibits insulin secretion. Objectives: To find factors that may serve as a clinical tool to identify neonates with transient neonatal hyperinsulinemia who may benefit from diazoxide treatment. Patients & methods: Retrospective chart review of neonates with transient hyperinsulinism hypoglycemia who were born between 01/01/2015 and 30/04/2018. Results: The study included 141 neonates (93 males). Thirty-four (24%) were treated with diazoxide. Mean gestational age (GA) was 36.0 ± 2.7 weeks (range: 26.2-41.4) and mean birth weight (BW) was 2.175 ± 0.699 Kg (range: 0.744-5.519). The diazoxide-treated and untreated groups were similar in perinatal (GA, BW, Apgar score) and maternal factors (age, number of pregnancies, number of deliveries, diabetes, hypertension, eclampsia). Diazoxide treatment was started at mean age of 14.6 ± 8.0 days (median 13.0, range: 5-35, 95% CI: 11.8-17.4) and discontinued on day 49.2 ± 40.2 of life (median 42.0, range: 14-224, 95% CI: 34.4-63.9). The treatment was well tolerated and without side effects (except for mild hypertrichosis). The maximal diazoxide dose was 7.1 ± 2.3 mg/kg/day (95% CI: 6.3-7.9). Diazoxide-treated neonates required a higher glucose infusion rate (GIR) compared to untreated neonates (16.6 ± 3.4 vs 10.4 ± 4.0 mg/kg/min, p<0.01), had a longer duration of intravenous fluids (15.9 ± 19.3 vs 7.8 ± 6.5 days, p<0.01), longer duration of hospitalization (32.8 ± 22.7 vs 20.4 ± 13.4 days, p<0.01), longer duration of carbohydrate supplementation (38.9 ± 40.4 vs 17.8 ± 21.4 days, p<0.01), and higher mean C-peptide levels (1.4 ± 0.9 vs 0.8 ± 0.5 ng/ml, p<0.01). Their insulin levels tended to be higher (3.5 ± 2.9 vs 2.2 ± 3.8 µU/ml, p=0.07). Summary: Neonates who were treated with diazoxide had a more severe clinical course manifested by higher glucose requirements, longer duration of intravenous glucose infusion, and longer duration of hospitalization. Higher C-peptide levels and higher GIR requirement may serve as a clinical tool to identify neonates with transient hyperinsulinism hypoglycemia who may benefit from diazoxide treatment.