Diazoxide for Neonatal Hyperinsulinemic Hypoglycemia and Pulmonary Hypertension

Hypoglycemia in neonates is associated with long-term neurodevelopmental effects. Hyperinsulinemic hypoglycemia (HH) is the most common cause of persistent hypoglycemia in neonatal intensive care units. Diazoxide is the only medication that is currently recommended for treatment of HH in neonates. However, the use of diazoxide in neonates is associated with pulmonary hypertension as an adverse effect. In this article, we review the literature on the mechanism of action and adverse effects with the use of diazoxide in neonatal hyperinsulinism. We then present a case series of neonates treated with diazoxide in our neonatal intensive care unit over a 5-year period. Among 23 neonates who received diazoxide, 4 developed pulmonary hypertension and 1 died. All infants who developed pulmonary hypertension were born preterm at less than 36 weeks gestation and had pre-existing risk factors for pulmonary hypertension. HH in preterm neonates, with pre-existing pulmonary hypertension or with risk factors for pulmonary hypertension requires thoughtful management.

Automated summary

Hypoglycemia in neonates is often caused by hyperinsulinemic hypoglycemia, and diazoxide is the recommended medication for treatment. However, the use of diazoxide in neonates can lead to adverse effects such as pulmonary hypertension, especially in preterm infants with pre-existing risk factors. This article reviews the mechanism of action and adverse effects of diazoxide and presents a case series of neonates treated with diazoxide, highlighting the importance of thoughtful management in preterm neonates with risk factors for pulmonary hypertension.