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Watchful waiting versus pharmacological management of small-for-gestational-age infants with hyperinsulinemic hypoglycemia
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 di...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10332304/ https://www.ncbi.nlm.nih.gov/pubmed/37435482 http://dx.doi.org/10.3389/fendo.2023.1163591 |
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author | Chandran, Suresh Jaya-Bodestyne, Sandra Lynn Rajadurai, Victor Samuel Saffari, Seyed Ehsan Chua, Mei Chien Yap, Fabian |
author_facet | Chandran, Suresh Jaya-Bodestyne, Sandra Lynn Rajadurai, Victor Samuel Saffari, Seyed Ehsan Chua, Mei Chien Yap, Fabian |
author_sort | Chandran, Suresh |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-10332304 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-103323042023-07-11 Watchful waiting versus pharmacological management of small-for-gestational-age infants with hyperinsulinemic hypoglycemia Chandran, Suresh Jaya-Bodestyne, Sandra Lynn Rajadurai, Victor Samuel Saffari, Seyed Ehsan Chua, Mei Chien Yap, Fabian Front Endocrinol (Lausanne) Endocrinology 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. Frontiers Media S.A. 2023-06-14 /pmc/articles/PMC10332304/ /pubmed/37435482 http://dx.doi.org/10.3389/fendo.2023.1163591 Text en Copyright © 2023 Chandran, Jaya-Bodestyne, Rajadurai, Saffari, Chua and Yap https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Endocrinology Chandran, Suresh Jaya-Bodestyne, Sandra Lynn Rajadurai, Victor Samuel Saffari, Seyed Ehsan Chua, Mei Chien Yap, Fabian Watchful waiting versus pharmacological management of small-for-gestational-age infants with hyperinsulinemic hypoglycemia |
title | Watchful waiting versus pharmacological management of small-for-gestational-age infants with hyperinsulinemic hypoglycemia |
title_full | Watchful waiting versus pharmacological management of small-for-gestational-age infants with hyperinsulinemic hypoglycemia |
title_fullStr | Watchful waiting versus pharmacological management of small-for-gestational-age infants with hyperinsulinemic hypoglycemia |
title_full_unstemmed | Watchful waiting versus pharmacological management of small-for-gestational-age infants with hyperinsulinemic hypoglycemia |
title_short | Watchful waiting versus pharmacological management of small-for-gestational-age infants with hyperinsulinemic hypoglycemia |
title_sort | watchful waiting versus pharmacological management of small-for-gestational-age infants with hyperinsulinemic hypoglycemia |
topic | Endocrinology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10332304/ https://www.ncbi.nlm.nih.gov/pubmed/37435482 http://dx.doi.org/10.3389/fendo.2023.1163591 |
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