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Endocrine Abstracts (2017) 51 OC1.2 | DOI: 10.1530/endoabs.51.OC1.2

BSPED2017 Oral Communications Oral Communications 1 (2 abstracts)

Neonatal hypoglycaemia: missed opportunities for detecting hyperinsulinism

Toby candler 1 , Chris Course 1 , Cora Doherty 1 & John Gregory 1,

1University Hospital Wales, Cardiff, UK; 2Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK.

Background: Timely diagnosis and management of neonatal hypoglycaemia is important due to associated short and long-term sequelae including neurodevelopmental delay. Hyperinsulinism should be distinguished from other causes of hypoglycaemia as management and acceptable glycaemic parameters may be different.

Aims: To characterize admissions with hypoglycaemia and assess the use of hypoglycaemia screen to detect hyperinsulinism.

Methods: Retrospective case note review of infants admitted to a tertiary neonatal unit between 1st January 2011 to 31st December 2014 with a primary diagnosis of hypoglycaemia.

Results: One hundred and two consecutive cases were reviewed (5.1–8.5% of total annual NICU admissions). Median gestational age=37.4 weeks (range=33.4–42.1), 64% of cases >37 weeks gestation. Median birthweight=2710.5 g (range=1600–4830 g). 88% of cases were classified as ‘infants at risk of hypoglycaemia’ by hospital guidelines. 76% had no history of maternal diabetes, 13% had mothers with gestational diabetes, 7% had mothers with type 1 diabetes and 4% had mothers with type 2 diabetes. 19% had evidence of neonatal sepsis, 27% had a maternal preeclampsia and 100% had an Apgar score >9 at 10 minutes. 83% had no hypoglycaemia screen. Cases with a glucose infusion rate (GIR) >8 mg/kg per min, 63% had no hypoglycaemia screen and >10 mg/kg per min, 53% had no hypoglycaemia screen. Twelve cases (12% of total) had biochemical evidence of hyperinsulinism, with 1/12 having a history of maternal diabetes (Type 2). Comparing those with hyperinsulinism with those with either normal hyposcreen or no screen taken; there was significantly longer duration of IV fluids (140.5hours vs. 59hours, P=0.003) and hospital stay (12.5 days vs 6 days, P=0.003) but no significant difference in birthweight (2425 g vs 2580 g, P=0.76), time to stable glucose (27 hours vs 19 hours, P=0.26) and GIR (10.25 mg/kg per min vs 6.0 mg/kg per min, P=0.12).

Conclusion: Hypoglycaemia is a common reason for admission to the neonatal unit. There were missed opportunities for a hypoglycaemia screen, especially in those with high GIR. Those with hyperinsulinism take longer to discontinue IV fluids and stay longer in hospital.

Volume 51

45th Meeting of the British Society for Paediatric Endocrinology and Diabetes

British Society for Paediatric Endocrinology and Diabetes 

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