Pulmonary hypertension and reopening of the ductus arteriosus in an infant treated with diazoxide

Demirel, Fatma; Ünal, Sevim; Çetin, İ̇brahim İ̇lker; Esen, İhsan; Araslı, Aslıhan

doi:10.1515/jpem.2011.238

Cited by 32 publications

(30 citation statements)

References 11 publications

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“…In 2008, it was approved for the treatment of patients with HIH, and its use is considered to be expanding rapidly. Although the usefulness of diazoxide for HIH is well established [11], several life-threatening complications have been reported [12,13,14]. …”

Section: Introductionmentioning

confidence: 99%

High Prevalence of Severe Circulatory Complications with Diazoxide in Premature Infants

Yoshida¹,

Kawai²,

Marumo³

et al. 2014

Neonatology

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Background: Since diazoxide was approved for clinical use in Japan in 2008, its prescription for the treatment of infants with hyperinsulinemic hypoglycemia (HIH) has rapidly expanded. Concomitantly, reports of complications associated with diazoxide are increasing. Objectives: To clarify the trends and problems associated with the treatment of infants with HIH, we planned a nationwide surveillance in Japan. Methods: Questionnaires were sent to 255 institutions belonging to the Japanese Neonatologist Association inquiring about neonatal cases of HIH from 2009 to 2011. Results: One hundred nineteen cases of neonates with transient HIH (THIH) related to perinatal problems and 15 cases with permanent HIH (PHIH; hypoglycemia persisting beyond a year) or genetic HIH were reported. Sixty-four infants (53.8%) with THIH were administered diazoxide, and the administration was completed within 3 months in 46 infants (71.9%). Fourteen of the PHIH or genetic cases were treated with diazoxide and 7 of them (50%) had hypoglycemia persisting beyond a year. Circulatory complications were reported in 15 infants, i.e. 10 with THIH and 5 with PHIH. Multiple regression analysis revealed that a younger gestational age at birth and higher maximum doses of diazoxide were significant risk factors for circulatory complications. Conclusions: Diazoxide is widely prescribed for infants with HIH as a first-line medicine in Japan, but prophylactic diuretics are uncommon. Under these circumstances, a high prevalence of severe circulatory complications in very-low-birth-weight infants was reported.

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Section: Introductionmentioning

confidence: 99%

High Prevalence of Severe Circulatory Complications with Diazoxide in Premature Infants

Yoshida¹,

Kawai²,

Marumo³

et al. 2014

Neonatology

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“…The most common adverse effect of diazoxide is hypertrichosis. Another side effect is water retention, which could cause serious problems such as congestive heart failure or the reopening of the ductus arteriosus [15,16]. These heart and vascular complications are mostly observed in preterm children, raising the question of its contraindication in premature patients.…”

Section: Discussionmentioning

confidence: 99%

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

Pan¹,

Zhang²,

Li³

2015

Horm Res Paediatr

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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.

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“…However, high sodium levels and fluid retention are commonly associated with diazoxide treatment. Diazoxide can induce pulmonary arterial hypertension with re-opening of the ductus arteriosus, hypoxia, and cardiac arrest [4]. Hypertrophic cardiomyopathy after prolonged treatment with diazoxide has been reported [5].…”

Section: Discussionmentioning

confidence: 99%

Diazoxide treatment for persistent hypoglycemia in a small for gestational age preterm infant with adequate low insulin levels

Arnon

Lagerev

Herzlich

et al. 2013

Case Reports in Perinatal Medicine

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Small for gestational age (SGA) newborn infants can have prolonged hypoglycemia due to diminished glycogen stores, diminished alternative energy substrates, or hyperinsulinism. Recurrent episodes of hypoglycemia are strongly correlated with persistent neuro-developmental and physical growth deficits. Treatment includes glucose supplements or medications affecting insulin secretion, gluconeogenesis, or glycogenolysis. Diazoxide suppresses insulin secretion by acting as an ATP-sensitive potassium channel agonist to prevent membrane depolarization, calcium influx, and insulin secretion. Therefore, it is used in persistent hypoglycemia of neonates associated with hyperinsulinism. We report a case of a female SGA preterm infant who had persistent hypoglycemia ( > 2 weeks of age) with low adequate serum insulin levels and no other clear biochemical evidence of hyperinsulinism or other abnormalities. As a result of an inability to control her glucose levels without high intravenous levels of glucose and continuous glucagon infusion, she was treated successfully with diazoxide, which was discontinued when the infant reached 5 kg. No side effects were noted. In rare cases of persistent hypoglycemia, and a need for high glucose infusion rate but with adequate low insulin levels even without biochemical evidence supportive of hyperinsulinism, diazoxide treatment can be offered with close monitoring of glucose levels and possible side effects. The exact mechanism is not clear and deserves further evaluation.

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Pulmonary hypertension and reopening of the ductus arteriosus in an infant treated with diazoxide

Cited by 32 publications

References 11 publications

High Prevalence of Severe Circulatory Complications with Diazoxide in Premature Infants

High Prevalence of Severe Circulatory Complications with Diazoxide in Premature Infants

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

Diazoxide treatment for persistent hypoglycemia in a small for gestational age preterm infant with adequate low insulin levels

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