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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...

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Autores principales: Chandran, Suresh, Jaya-Bodestyne, Sandra Lynn, Rajadurai, Victor Samuel, Saffari, Seyed Ehsan, Chua, Mei Chien, Yap, Fabian
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
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.
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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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