Late presentation of necrotizing enterocolitis associated with rotavirus infection in a term infant with hyperinsulinism on octreotide therapy

Abstract

Rationale:Congenital hyperinsulinism (CHI) is the most common cause of persistent hypoglycemia in infancy that can cause permanent brain damage. Consequently, optimal management is extremely important. Current pharmacologic and surgical treatment were available that included diazoxide and octreotides.Patient concerns:A 4 month old Saudi male patient diagnosed at our hospital as CHI, treated with near total pancreatectomy and octreotide therapy of 30 mcg/kg/day presented with severe abdominal distension, vomiting and bloody diarrhea.Diagnoses:The patient was diagnosed as necrotising enterocolitis (NEC) associated with Rota virus infection which played together with octeriotides as risk factors for NEC.Interventions:Radiological investigations and multidisciplinary team management with endocrinologist, neonatologist, pediatric surgeon, and gastroenterologist.Outcomes:Resolution of NEC with conservative medical management and was discharged after 1 month of hospital stay with follow up with all concerned sub specialties.Lessons:NEC can develop in patients treated with octreotides especially when associated with another risk factor such as rotavirus infection.

Necrotizing Enterocolitis in Neonates With Hyperinsulinemic Hypoglycemia Treated With Diazoxide

“…An alternative explanation is that diazoxide might reduce splanchnic perfusion as reported in infants with HH treated with octreotide who developed NEC. 16,[26][27][28][29] With our series, we report an increased incidence of NEC in a subset of patients with HH. All cases were infants born at or ,37 weeks'…”

Somatostatin analogues for the treatment of hyperinsulinaemic hypoglycaemia

“…Hepatitis, cholestasis and gallstones Demirbilek et al, 126 Levy-Khademi et al, 236 Avatapalle et al, 162 Ben-Ari et al, 77 Malik et al, 181 Koren et al, 78 Radetti et al, 124 Glaser et al 139 Necrotizing enterocolitis Laje et al, 238 Hawkes et al, 134 Abdel Khalek and Kandil 138 Alsaedi et al, 150 McMahon et al, 108 Reck-Burneo et al 239 Tachyphylaxis Thornton et al, 3 Hawdon et al 130 Inhibition of other hormones Aynsley-Green et al 69 Gastrointestinal dysmotility Glaser et al 139 Paradoxical hyperglycaemia and bradycardia Batra et al 173 Prolonged QT interval Celik et al 83 Deceleration of growth Yorifuji et al 113 Seizure after stopping octreotide Bas et al 169 Necrotizing enterocolitis Necrotizing enterocolitis (NEC) is a disease mainly of premature infants and associated with a high mortality rate. It typically presents with abdominal distension, bilious vomiting and bloody stools, which can lead to sepsis and shock in severe cases.…”