#65 Frequency and etiology of persistent neonatal hypoglycemia using 2015 pediatric endocrine society more stringent hypoglycemia guidelines
Rozeanna Skovrlj, University of Manitoba; Celia Rodd, University of Manitoba; Seth Marks, University of Manitoba
The Sections of Pediatric Endocrinology and Neonatology revised the protocol for persistent neonatal hypoglycemia based on the 2015 recommendations from the Pediatric Endocrine Society (PES). Previously, euglycemia was defined as > 2.6mmol/L at >72 hours of life. The 2015 protocol states that a glucose of < 3.3mmol/L at >72 hours triggers a critical blood sample and a Pediatric Endocrinology consultation. Our objectives were to determine if there was an increase in the number of consults after implementing the 2015 protocol and to evaluate the etiologies of persistent hypoglycemia.
A retrospective chart review was conducted for all Endocrine consults from November 2011 to October 2016. Data extracted included age of infant, critical sample values, management, anthropometric measures, and maternal lifestyle and health. Descriptive statistical analyses were performed. Interrupted time series analysis assuming a Poisson distribution was used for primary objective analysis.
Fifty-eight infants were evaluated. Post-intervention there was a significant increase in the number of consults by 3.2 cases/quarter (p<0.03) 95% CI (1.14-8.93). Most infants had documented hypoglycemia within hours post-birth. Half were IUGR; 75% were male. The median age for investigation was 7 days with a mean glucose of 2.3 mmol/L. Hyperinsulinism was the most common etiology (52/58 infants); diazoxide treatment was utilized in 52% (30/58) with a median length of treatment of 87 days. The phenotype of the infants and duration of treatment pre- and post-PES protocol did not differ statistically.
Not surprisingly there was significant increase in the number of infants with persistent hypoglycemia using the new guidelines. Prolonged hyperinsulinism that was successfully managed medically was the major cause of hypoglycemia. We postulate that infants diagnosed using the 2015 guidelines have real disease. The increase from 2.6mM to 3.3mM was large. An intermediate cutoff could be considered while balancing the risks of unrecognized hypoglycemia.