Postoperative Surveillance and Detection of Postprandial Hypoglycemia after Fundoplasty in Children

Abstract

Objective To evaluate the prevalence of postprandial hypoglycemia (PPH) after fundoplasty after the initiation of a universal postoperative glucose surveillance plan in the neonatal intensive care unit (NICU). Study design This was a retrospective chart review of children (newborn to 18 years) who underwent fundoplasty at The Children’s Hospital of Philadelphia during the 2-year-period after the launch of a surveillance protocol in the NICU and other units. The rate of screening, frequency of PPH (postprandial blood glucose <60 mg/dL [3.3 mmol/L] on 2 occasions), frequency of postprandial hyperglycemia preceding PPH, timing of PPH presentation, and related symptoms were evaluated. Results A total of 285 children were included (n = 64 in the NICU; n = 221 in other units). Of the children screened in all units, 24.0% showed evidence of PPH, compared with 1.3% of unscreened children. Hyperglycemia preceded PPH in 67.7% (21/31) of all screened children. Within the NICU, most children had PPH within 1 week, but only 53.3% exhibited symptoms of dumping syndrome. Conclusions This study supports the use of universal postoperative blood glucose surveillance in identifying PPH in children after fundoplasty. Earlier identification of PPH would lead to earlier treatment and minimize the effects of unidentified hypoglycemic events.

Should bariatric surgery be performed in adolescents?

“…The dumping syndrome is often quoted, as mentioned previously, to be a major drawback of RYGB surgery (30,32). In our unit, we have shown that most patients, including adolescents, do not experience any symptoms of dumping after RYGB (31), although the prevalence has been reported elsewhere at over 75% (105).…”

“…The dumping syndrome is divided into early dumping, with gastrointestinal symptoms, and late dumping, typically occurring 1-3 h after a meal without gastrointestinal symptoms (30). Dumping has been reported in adolescents after 32).…”

Recommendations from the Pediatric Endocrine Society for Evaluation and Management of Persistent Hypoglycemia in Neonates, Infants, and Children

“…Postprandial hypoglycemia is often preceded by exaggerated glucose, glucagon-like peptide-1, and insulin responses, which can be detected on an oral glucose or mixed-meal tolerance test. 35 Values Failure to investigate a neonate, infant, or child with suspected hypoglycemia increases the risk of delaying a definitive diagnosis and instituting effective treatment. Expeditiously identifying the specific cause of hypoglycemia, as outlined above, will enable prompt institution of appropriate treatment and decrease the risk of permanent brain injury from persistent and recurrent severe hypoglycemia.…”

Rate of Serious Adverse Events Associated with Diazoxide Treatment of Patients with Hyperinsulinism

“…Syndromal hyperinsulinism is rare and may be associated with Kabuki, Beckwith-Wiedemann, Soto, Usher, and Turner Syndrome. Finally, miscellaneous forms of hyperinsulinism occur in insulinoma, glucose dumping associated with gastrointestinal surgery such as Nissen fundoplication and post bariatric surgery in adults [8]. …”