Experience of Octreotide Therapy for Hyperinsulinemic Hypoglycemia in Neonates Born Small for Gestational Age: A Case Series

Abstract

Aims: Hyperinsulinemic hypoglycemia (HH) is common in small-for-gestational-age (SGA) neonates. Diazoxide is often used as the first-line medication for HH in SGA neonates. Unfortunately, diazoxide is not authorized in China. We examined the effectiveness of octreotide as an alternative therapy to treat HH in SGA neonates. There is limited data on the use of octreotide in HH of SGA neonates. Methods: Seven SGA neonates with HH who were admitted to the Department of Neonatology at the Third Affiliated Hospital of Sun Yat-sen University between January 2013 and December 2014 received octreotide at an initial dose of 5 μg/kg/day through subcutaneous injection at 8-hour intervals. Depending on the glycemic control, the dose of octreotide was increased in increments of 2-5 μg/kg/day every 3-5 days to the maximum dose of 30 μg/kg/day. Results: The age of neonates with HH diagnosis ranged from 1 to 4 days. The maximum dose of octreotide ranged from 8 to 18 μg/kg/day. The duration of octreotide therapy ranged from 9 to 45 days. All patients had a clear glycemic response to octreotide, and no major adverse events were observed during the treatment. Conclusions: Octreotide may be a useful alternative therapy in HH of SGA neonates when diazoxide is unavailable.

Hyperinsulinemic Hypoglycemia in Neonates Due to Perinatal Stress: A Case Series

“…In our study, 100% responded to medical treatment, whereas it was 80-95% in published literature [4,5]. Pan, et al [6] reported their experience of octreotide therapy for HI in 7 cases of SGA neonates with treatment duration between 9 to 45 days, and with an excellent response to treatment in all patients. As all babies remained admitted till the treatment was completed and responded well to medications, we suspected it due to perinatal stress; therefore, genetic analysis was not considered.…”

Somatostatin analogues for the treatment of hyperinsulinaemic hypoglycaemia

“…Interestingly, in some parts of the world where diazoxide is not available then octreotide has been used even as a first line therapy. 176 SST analogues have also been used in the long term where in some patients with severe HH the need for pancreatectomy can be avoided. 14 The dose range is typically between 5 and 25 µg/kg per day (maximum dose can go to 40 µg/kg per day) administered either intravenously, subcutaneously by continuous infusion, or as 6–8 hourly subcutaneous injections for short- and long-term treatment of hyperinsulinaemia.…”

“…A case series of neonates born small for gestational age with HH were successfully treated with octreotide infusion and the blood glucose was corrected with no complications. 176 …”