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Safety and efficacy of low-dose diazoxide in small-for-gestational-age infants with hyperinsulinaemic hypoglycaemia
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  • Published on:
    Low dose Diazoxide for Hyper-insulinemic hypoglycemia- Do we agree?
    • Supreet Khurana, Assistant Professor, Neonatology Government Medical College and Hospital, Chandigarh

    We read with great interest this article published by Chandran et al. However, we have some critical
    reservations on implementation of low dose diazoxide. The target blood glucose thresholds used for
    management have been taken from Pediatric endocrine society guidelines of 2015, which are based
    on adult neuroglycopenic effects. However, AAP guidelines recommend a lower treatment target of
    <2.2 mmol/l (40 mg/dl) for asymptomatic,<2.5 mmol/l (45 mg/dl) for symptomatic neonates
    during first 48 hours and <3.3 mmol/l (60mg/dl) thereafter (1, 2) . Moreover, in a recent multi-centric
    trial published by Kempen et al; it was concluded that low treatment threshold of <2 mmol/l (36
    mg/dl) was non inferior in terms of neurodevelopmental outcomes at 18 months of age in healthy
    asymptomatic neonates (3) . Hence it is still debatable whether all the neonates being managed for
    hypoglycemia warranted an intravenous glucose infusion therapy and diazoxide.
    Authors have used a combination of starting dose of diazoxide along with hydrochlorothiazide for
    management of SGA neonates; which are known to have a synergistic effect on increasing blood
    glucose levels, hence actual dose of diazoxide required if used alone could have been potentially
    higher in these neonates.
    In the study design the authors have mentioned that this was an observational cohort study,
    however neither the absence of compar...

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    Conflict of Interest:
    None declared.