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• Letter/Comments to Editor on paper “Necrotizing enterocolitis in newborns receiving Diazoxide” published in ADC Fetal Neonatal Ed 2020; 0: F1-F5.
  Kaarthigeyan Kalaniti, Veronica Mugarab-Samedi and Sibasis Daspal
  Published on: 28 April 2021
• Letter/Comments to Editor on paper “Necrotizing enterocolitis in newborns receiving Diazoxide” published in ADC Fetal Neonatal Ed 2020; 0: F1-F5.
  Kaarthigeyan Kalaniti, Veronica Mugarab-Samedi, Sibasis Daspal and Neil Wonko
  Published on: 2 March 2021

• Published on: 28 April 2021

  Letter/Comments to Editor on paper “Necrotizing enterocolitis in newborns receiving Diazoxide” published in ADC Fetal Neonatal Ed 2020; 0: F1-F5.

  • Kaarthigeyan Kalaniti, Neonatology, Clinical associate Division of Neonatology, Dept. of Pediatrics, Jim Pattison Children’s Hospital, University of Saskatchewan
  • Other Contributors:
    • Veronica Mugarab-Samedi, Hospitalist
    • Sibasis Daspal, Neonatologist

  Dear Editor,
  We read with interest the paper from our colleagues in Toronto on the possible association between the use of diazoxide treatment for hypoglycemia and the onset of necrotizing enterocolitis (NEC). We wish to share our single-center experience on diazoxide and we beg to differ with the authors. Our NICU is a tertiary care center from Midwest Canada that has the least incidence of NEC across all the centers in Canada as per Canadian Neonatal Network (CNN) database. For nearly 2 decades, we have been using diazoxide in our unit, in the treatment of persistent neonatal hypoglycemia among intra-uterine growth retardation, small-for-gestational age, infant of a diabetic mother, and transient hyperinsulinemic hypoglycemia neonates.
  Our neonates are comparable to Toronto population, with prematurity, and other risk factors. We have used both moderate doses (5-10mg/kg/day) and higher doses (maximum up to 15mg/kg/day) in 3 divided doses in our practice. Over the last 10 years (between the years 2010-2020), 164 neonates have received diazoxide treatment in our NICU and none of them have had NEC as a complication of treatment during or after the therapy. Common side-effects of diazoxide in infants and children include nausea, vomiting, loss of appetite, headache, dizziness, stomach pain or upset, diarrhea, changes in sense of taste, hypertrichosis (especially in women and children), anxiety, weakness, pruritus or skin rash. We agree as the authors mentioned on...

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  Dear Editor,
  We read with interest the paper from our colleagues in Toronto on the possible association between the use of diazoxide treatment for hypoglycemia and the onset of necrotizing enterocolitis (NEC). We wish to share our single-center experience on diazoxide and we beg to differ with the authors. Our NICU is a tertiary care center from Midwest Canada that has the least incidence of NEC across all the centers in Canada as per Canadian Neonatal Network (CNN) database. For nearly 2 decades, we have been using diazoxide in our unit, in the treatment of persistent neonatal hypoglycemia among intra-uterine growth retardation, small-for-gestational age, infant of a diabetic mother, and transient hyperinsulinemic hypoglycemia neonates.
  Our neonates are comparable to Toronto population, with prematurity, and other risk factors. We have used both moderate doses (5-10mg/kg/day) and higher doses (maximum up to 15mg/kg/day) in 3 divided doses in our practice. Over the last 10 years (between the years 2010-2020), 164 neonates have received diazoxide treatment in our NICU and none of them have had NEC as a complication of treatment during or after the therapy. Common side-effects of diazoxide in infants and children include nausea, vomiting, loss of appetite, headache, dizziness, stomach pain or upset, diarrhea, changes in sense of taste, hypertrichosis (especially in women and children), anxiety, weakness, pruritus or skin rash. We agree as the authors mentioned on the occurrence of transient fluid retention, pulmonary edema, elevated pulmonary pressures, and brief oxygen dependency during and after the diazoxide treatment as side effects in neonates.
  The authors have highlighted that seven (13%) out of fifty-five neonates developed NEC after diazoxide treatment. [1] And of the 7 patients, one patient was exposed to octreotide. [1] Octreotide has already been known to have proven hemodynamic side-effects on splanchnic circulation, thereby predisposing these vulnerable population leading to NEC. When the baby is receiving octreotide, there could have been a cascade of hemodynamic changes in the gut which could be monitored by NIRS or abdominal Doppler studies to assess gut blood flow. As the authors mention, Gray KD et al. reported 1066 neonates treated with diazoxide for hypoglycemia, less than 1% of neonates developed NEC. In our center, we decided to use diazoxide as a monotherapy in the treatment of neonatal hypoglycemia. Diazoxide did not cause any alterations in the intestinal blood flow which was monitored by near-infrared spectroscopy (NIRS). According to Table.3 in the paper, there were no significant difference between the diazoxide initial dose and maximum dose used between the NEC vs. no NEC group.
  Thus, diazoxide has been used in our center successfully with no major side-effects. It also helped in shortening the duration of stay and cost of treatment substantially thereby reducing the burden on our provincial healthcare system.
  Kaarthigeyan Kalaniti1, Veronica Samedi1, Neil Wonko1, Sibasis Daspal1
  1Division of Neonatology, Dept. of Pediatrics,
  Jim Pattison Children’s Hospital,
  University of Saskatchewan, Saskatoon, SK, Canada
  E-mail: vmsamedi@gmail.com

  References:
  1. Prado LA, Castro M, Weisz DE, et al. Arch Dis Child Fetal Neonatal Ed. 2020; 0: F1–F5.

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  Conflict of Interest:
  None declared.

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• Published on: 2 March 2021

  Letter/Comments to Editor on paper “Necrotizing enterocolitis in newborns receiving Diazoxide” published in ADC Fetal Neonatal Ed 2020; 0: F1-F5.

  • Kaarthigeyan Kalaniti, Hospitalist Division of Neonatology, Dept. of Pediatrics, Jim Pattison Children’s Hospital, University of Saskatchewan
  • Other Contributors:
    • Veronica Mugarab-Samedi, Hospitalist
    • Sibasis Daspal, Neonatologist
    • Neil Wonko, Neonatologist

  Dear Editor,
  We read with interest the paper from our colleagues in Toronto on the possible association between the use of diazoxide treatment for hypoglycemia and the onset of necrotizing enterocolitis (NEC). We wish to share our single-center experience on diazoxide and we beg to differ with the authors. Our NICU is a tertiary care center from Midwest Canada that has the least incidence of NEC across all the centers in Canada as per Canadian Neonatal Network (CNN) database. For nearly 2 decades, we have been using diazoxide in our unit, in the treatment of persistent neonatal hypoglycemia among intra-uterine growth retardation, small-for-gestational age, infant of a diabetic mother, and transient hyperinsulinemic hypoglycemia neonates.
  Our neonates are comparable to Toronto population, with prematurity, and other risk factors. We have used both moderate doses (5-10mg/kg/day) and higher doses (maximum up to 15mg/kg/day) in 3 divided doses in our practice. Over the last 10 years (between the years 2010-2020), 164 neonates have received diazoxide treatment in our NICU and none of them have had NEC as a complication of treatment during or after the therapy. Common side-effects of diazoxide in infants and children include nausea, vomiting, loss of appetite, headache, dizziness, stomach pain or upset, diarrhea, changes in sense of taste, hypertrichosis (especially in women and children), anxiety, weakness, pruritus or skin rash. We agree as the authors mentioned on...

  Show More

  Dear Editor,
  We read with interest the paper from our colleagues in Toronto on the possible association between the use of diazoxide treatment for hypoglycemia and the onset of necrotizing enterocolitis (NEC). We wish to share our single-center experience on diazoxide and we beg to differ with the authors. Our NICU is a tertiary care center from Midwest Canada that has the least incidence of NEC across all the centers in Canada as per Canadian Neonatal Network (CNN) database. For nearly 2 decades, we have been using diazoxide in our unit, in the treatment of persistent neonatal hypoglycemia among intra-uterine growth retardation, small-for-gestational age, infant of a diabetic mother, and transient hyperinsulinemic hypoglycemia neonates.
  Our neonates are comparable to Toronto population, with prematurity, and other risk factors. We have used both moderate doses (5-10mg/kg/day) and higher doses (maximum up to 15mg/kg/day) in 3 divided doses in our practice. Over the last 10 years (between the years 2010-2020), 164 neonates have received diazoxide treatment in our NICU and none of them have had NEC as a complication of treatment during or after the therapy. Common side-effects of diazoxide in infants and children include nausea, vomiting, loss of appetite, headache, dizziness, stomach pain or upset, diarrhea, changes in sense of taste, hypertrichosis (especially in women and children), anxiety, weakness, pruritus or skin rash. We agree as the authors mentioned on the occurrence of transient fluid retention, pulmonary edema, elevated pulmonary pressures, and brief oxygen dependency during and after the diazoxide treatment as side effects in neonates.
  The authors have highlighted that seven (13%) out of fifty-five neonates developed NEC after diazoxide treatment. [1] And of the 7 patients, one patient was exposed to octreotide. [1] Octreotide has already been known to have proven hemodynamic side-effects on splanchnic circulation, thereby predisposing these vulnerable population leading to NEC. When the baby is receiving octreotide, there could have been a cascade of hemodynamic changes in the gut which could be monitored by NIRS or abdominal Doppler studies to assess gut blood flow. As the authors mention, Gray KD et al. reported 1066 neonates treated with diazoxide for hypoglycemia, less than 1% of neonates developed NEC. In our center, we decided to use diazoxide as a monotherapy in the treatment of neonatal hypoglycemia. Diazoxide did not cause any alterations in the intestinal blood flow which was monitored by near-infrared spectroscopy (NIRS). According to Table.3 in the paper, there were no significant difference between the diazoxide initial dose and maximum dose used between the NEC vs. no NEC group.
  Thus, diazoxide has been used in our center successfully with no major side-effects. It also helped in shortening the duration of stay and cost of treatment substantially thereby reducing the burden on our provincial healthcare system.
  Kaarthigeyan Kalaniti1, Veronica Samedi1, Neil Wonko1, Sibasis Daspal1
  1Division of Neonatology, Dept. of Pediatrics,
  Jim Pattison Children’s Hospital,
  University of Saskatchewan, Saskatoon, SK, Canada
  E-mail: vmsamedi@gmail.com

  References:
  1. Prado LA, Castro M, Weisz DE, et al. Arch Dis Child Fetal Neonatal Ed. 2020; 0: F1–F5.
  2. Gray KD, Dudash K, Escobar C, et al. Prevalence and safety of diazoxide in the neonatal intensive care unit. J Perinatol 2018; 38: 1496-502.

  Show Less

  Conflict of Interest:
  None declared.

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