ATP-Sensitive Potassium Channels (KATP) Play a Role in Hypoxic Preconditioning Against Neonatal Hypoxic-Ischemic Brain Injury

Feng, Zhong‐Ping; Sun, Hong‐Shuo

doi:10.1007/978-3-319-45345-3_7

Cited by 3 publications

(3 citation statements)

References 130 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…suggest that it is an association rather than causation ( 22 ). The biological mechanism of these side effects may be due to the persistent hyperpolarization of neuronal and intestinal cells since DZX is a K ATP channel agonist ( 10 , 23 ).…”

Section: Discussionmentioning

confidence: 99%

“…#Paired glucose/insulin levels measured after 48 h of life as part of critical samples to diagnose hyperinsulinism DZX, diazoxide; GIR, glucose infusion rate; HH, hyperinsulinemic hypoglycemia; WW, watchful waiting. mechanism of these side effects may be due to the persistent hyperpolarization of neuronal and intestinal cells since DZX is a K ATP channel agonist (10,23).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Watchful waiting versus pharmacological management of small-for-gestational-age infants with hyperinsulinemic hypoglycemia

et al. 2023

View full text Add to dashboard Cite

IntroductionGiven that reports on severe diazoxide (DZX) toxicity are increasing, we aimed to understand if the short-term clinical outcomes of small-for-gestational-age (SGA) infants with hyperinsulinemic hypoglycemia (HH) managed primarily by supportive care, termed watchful waiting (WW), are different from those treated with DZX.MethodA real-life observational cohort study was conducted from 1 September 2014 to 30 September 2020. The WW or DZX management decision was based on clinical and biochemical criteria. We compared central line duration (CLD), postnatal length of stay (LOS), and total intervention days (TIDs) among SGA-HH infants treated with DZX versus those on a WW approach. Fasting studies determined the resolution of HH.ResultAmong 71,836 live births, 11,493 were SGA, and 51 SGA infants had HH. There were 26 and 25 SGA-HH infants in the DZX and WW groups, respectively. Clinical and biochemical parameters were similar between groups. The median day of DZX initiation was day 10 of life (range 4–32), at a median dose of 4 mg/kg/day (range 3–10). All infants underwent fasting studies. Median CLD [DZX, 15 days (6–27) vs. WW, 14 days (5–31), P = 0.582] and postnatal LOS [DZX, 23 days (11–49) vs. WW, 22 days (8–61), P = 0.915] were comparable. Median TID was >3-fold longer in the DZX than the WW group [62.5 days (9–198) vs. 16 days (6–27), P < 0.001].ConclusionCLD and LOS are comparable between WW and DZX groups. Since fasting studies determine the resolution of HH, physicians should be aware that clinical intervention of DZX-treated SGA-HH patients extends beyond the initial LOS.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Watchful waiting versus pharmacological management of small-for-gestational-age infants with hyperinsulinemic hypoglycemia

et al. 2023

View full text Add to dashboard Cite

show abstract

“…27 Diazoxide blocks the neuronal K ATP channel causing hyperpolarization and thereby the potential to cause brain injury. 28 A normal hepatic and renal function tests and cardiac evaluation before diazoxide initiation are prerequisites to avoid complications. 29 Regular follow-up appointments continue with neonatologist, endocrinologist, neurologist, and neurosurgeon.…”

Section: Discussionmentioning

confidence: 99%

Asymptomatic Hyperinsulinemic Hypoglycemia and Grade 4 Intraventricular Hemorrhage in a Late Preterm Infant

Banas

Viswalingam

Rajadurai

et al. 2021

Journal of Investigative Medicine High Impact Case Reports

View full text Add to dashboard Cite

Hyperinsulinemic hypoglycemia (HH) has the potential to cause acute neurologic dysfunction and neurodevelopmental impairment. Parieto-occipital neuronal injuries have been reported in hypoglycemic infants, but intraparenchymal hemorrhage is rare. On day 5 of life, a late preterm infant was transferred to our care with recurrent asymptomatic hypoglycemia. Prior to arrival, plasma glucose levels were at a median of 1.25 mmol/L (22.5 mg/dL) in the first 6 hours of life, and he required a glucose infusion rate (GIR) of 22.6 mg/kg/min. Hyperinsulinism was confirmed in the presence of detectable insulin, low ketones, and fatty acid when hypoglycemic. A left grade 4 intraventricular hemorrhage (IVH) was noted in the cranial ultrasound scan during the workup for sepsis on the day of admission. However, magnetic resonance imaging of the brain on day 7 of life revealed extensive bilateral IVH. On day 9, he was initiated on diazoxide, and HH resolved within 48 to 72 hours, allowing increment of feeds while weaning GIR. Ventricular drain for post-hemorrhagic ventriculomegaly was advised but not performed. At 3 months, post-hemorrhagic ventriculomegaly was stable, and there were early signs of neurodevelopmental delay. After discontinuing diazoxide at 4 months of age, he passed an 8-hour fasting study confirming the resolution of HH. Severe hypoglycemia has been associated with cerebral hyperperfusion in preterm infants and potentially could cause IVH. Close monitoring and prompt intervention in preterm infants to prevent severe hypoglycemia are paramount. In addition to long-term neurodevelopmental follow-up, infants with recurrent hypoglycemia may benefit from neuroimaging and thereby early intervention if required.

show abstract

Safety and efficacy of low-dose diazoxide in small-for-gestational-age infants with hyperinsulinaemic hypoglycaemia

Chandran

Pravin

Chien

et al. 2021

Arch Dis Child Fetal Neonatal Ed

View full text Add to dashboard Cite

ObjectivesDiazoxide (DZX) is the drug of choice for treating hyperinsulinaemic hypoglycaemia (HH), and it has potentially serious adverse effects. We studied the safety and efficacy of low-dose DZX in small-for-gestational-age (SGA) infants with HH.DesignAn observational cohort study from 1 September 2014 to 31 September 2020.SettingA tertiary Women’s and Children’s Hospital in Singapore.PatientsAll SGA infants with HH.InterventionDiazoxide, at 3–5 mg/kg/day.Main outcome measuresShort-term outcomes; adverse drug events and fasting studies to determine ‘safe to go home’ and ‘resolution’ of HH.ResultsAmong 71 836 live births, 11 493 (16%) were SGA. Fifty-six (0.5%) SGA infants with HH were identified, of which 27 (47%) with a mean gestational age of 36.4±2 weeks and birth weight of 1942±356 g required DZX treatment. Diazoxide was initiated at 3 mg/kg/day at a median age of 10 days. The mean effective dose was 4.6±2.2 mg/kg/day, with 24/27 (89%) receiving 3–5 mg/kg/day. Generalised hypertrichosis occurred in 2 (7.4%) and fluid retention in 1 (3.7%) infant. A fasting study was performed before home while on DZX in 26/27 (96%) cases. Diazoxide was discontinued at a median age of 63 days (9–198 days), and resolution of HH was confirmed in 26/27 (96%) infants on passing a fasting study.ConclusionOur study demonstrates that low-dose DZX effectively treats SGA infants with HH as measured by fasting studies. Although the safety profile was excellent, minimal adverse events were still observed with DZX, even at low doses.

show abstract

ATP-Sensitive Potassium Channels (KATP) Play a Role in Hypoxic Preconditioning Against Neonatal Hypoxic-Ischemic Brain Injury

Cited by 3 publications

References 130 publications

Watchful waiting versus pharmacological management of small-for-gestational-age infants with hyperinsulinemic hypoglycemia

Watchful waiting versus pharmacological management of small-for-gestational-age infants with hyperinsulinemic hypoglycemia

Asymptomatic Hyperinsulinemic Hypoglycemia and Grade 4 Intraventricular Hemorrhage in a Late Preterm Infant

Safety and efficacy of low-dose diazoxide in small-for-gestational-age infants with hyperinsulinaemic hypoglycaemia

Contact Info

Product

Resources

About