Continuous Intragastric Dextrose: A Therapeutic Option for Refractory Hypoglycemia in Congenital Hyperinsulinism.

TitleContinuous Intragastric Dextrose: A Therapeutic Option for Refractory Hypoglycemia in Congenital Hyperinsulinism.
Publication TypeJournal Article
Year of Publication2019
AuthorsVajravelu MEllen, Congdon M, Mitteer L, Koh J, Givler S, Shults J, De León DD
JournalHorm Res Paediatr
Volume91
Issue1
Pagination62-68
Date Published2019
ISSN1663-2826
KeywordsBody Mass Index, Congenital Hyperinsulinism, Female, Follow-Up Studies, Glucose, Humans, Infant, Infant, Newborn, Male, Retrospective Studies
Abstract

Feeding problems are frequent in infants with congenital hyperinsulinism (HI) and may be exacerbated by continuous enteral nutrition (EN) used to maintain euglycemia. Our center's HI team uses dextrose solution given continuously via gastric tube (intrasgastric dextrose, IGD) for infants not fully responsive to conventional medical therapy or pancreatectomy. Here, we describe our practice as well as growth, feeding, and adverse events in infants with HI exposed to IGD.

METHODS: This was a retrospective cohort of infants with HI treated with IGD from 2009-2017. Primary outcomes were weight-for-length and body mass index Z-scores (WFL-Z and BMI-Z) in the year following IGD initiation. Secondary outcomes included EN use and adverse events. We used multivariable regression to assess covariates of interest.

RESULTS: We studied 32 subjects (13 female) with a median age at IGD initiation of 73 days (range 17-367); median follow-up was 11.2 months (range 5.0-14.2). WFL-Z did not change significantly over time (p > 0.05). EN use decreased significantly over time, i.e., at 0 months: 72% (95% CI 53-85) vs. at 12 months 39% (95% CI 22-59). No potential adverse events led to discontinuation of IGD.

CONCLUSIONS: Over a median follow-up of nearly 1 year, IGD was well-tolerated, with no change in WFL-Z or BMI-Z from baseline.

DOI10.1159/000491105
Alternate JournalHorm Res Paediatr
PubMed ID30086540
PubMed Central IDPMC6661174
Grant ListK12 DK094723 / DK / NIDDK NIH HHS / United States
R01 DK098517 / DK / NIDDK NIH HHS / United States
T32 DK007314 / DK / NIDDK NIH HHS / United States