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

Thornton, Paul; Stanley, Charles A.; León, Diva D. De; Harris, Deborah L; Haymond, Morey W.; Hussain, Khalid; Levitsky, Lynne L.; Murad, M. Hassan; Rozance, Paul J.; Simmons, Rebecca A.; Sperling, Mark A.; Weinstein, David A.; White, Neil H.; Wolfsdorf, Joseph I.

doi:10.1016/j.jpeds.2015.03.057

Cited by 468 publications

(447 citation statements)

References 40 publications

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“…For this reason, the Pediatric Endocrine Society guide for hypoglycemia in neonates recommends that in the first 24-48 hours of life primary focus should be on stabilization of glucose levels; whereas, after 48 hours, neonates whose glucose values remain low or who have other risk factors should be evaluated to determine the etiology of hypoglycemia and ensure their safety prior to discharge. (18) So; we also suggest sending work up after 48 hours. If workup is diagnostic of hyperinsulinemia then therapy should be instituted.…”

Section: Follow Upmentioning

confidence: 99%

A Brief Review of Hyperinsulinism in Small for Gestational Age Infants

Kumar¹

2017

jmscr

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Section: Follow Upmentioning

confidence: 99%

A Brief Review of Hyperinsulinism in Small for Gestational Age Infants

Kumar¹

2017

jmscr

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“…As more evidence appeared in the literature to support specific diagnostic and therapeutic options, specialty societies began to establish clinical guidelines that might be applied to manage a specific condition [3][4][5][6][7][8][9]. Creation of such pathways was the result of the amalgamation of medical evidence gleaned from the literature and the combined experience of experts tasked with writing these care plans.…”

Section: Standardizationmentioning

confidence: 99%

Reducing Cost Through Standardization

Friedman

Fulton

2016

Curr Treat Options Peds

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Opinion statementThe drive for standardization of care within pediatrics based on medical evidence is gaining momentum among hospitals and providers. Initiated by care guidelines with origins in specialty societies, adoption of pathways is now being implemented in many settings. The keys to success of these algorithms in narrowing practice variation and their potential contribution to reducing utilization of unnecessary resources are not uniformly addressed in advance. Clinical guidelines are often not updated frequently to incorporate new evidence from the literature. Education of providers about the goals and process of pathways in advance may not be sufficient depending on the commitment of the clinical champions of the algorithms. Anticipatory modeling to identify potential barriers in the workflow that interfere with proper implementation of pathways is beneficial with the opportunity to refine the algorithm where appropriate. In order to confirm cost reduction, economic data points need to be defined in advance for comparisons between preimplementation and post-implementation periods. It is possible that improved outcomes from narrowed practice variation may not always lead to cost reduction which should be reconciled by analysis of the data. Our experience with these limitations motivated our Department of Cardiology to seek a different approach to care pathways, standardized clinical and management pathways (SCAMPs) which engender algorithm design informed by existing evidence and experience of clinicians coupled with targeted questions that can be addressed by active data collection. Providers are free to depart from recommendations in the algorithm but must explain their reasons, an option that promotes participation. Data analysis combined with new medical evidence leads to iterative changes, greater standardization, and reduction of cost.

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“…14 The first 48 hours of life is a period of transitional glucose regulation; in this time period, normal neonates have plasma glucose concentrations which are lower compared to later in life. After the first two to three days of life, mean plasma glucose levels do not differ from infants, older children, or adults (70-100 mg/dL).…”

Section: Hypoglycemiamentioning

confidence: 99%

Key Developments in Pediatric Endocrinology in 2015

Eshragh

LaFranchi²

2016

US Endocrinology

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The year 2015 brought many exciting discoveries and key developments in the field of pediatric endocrinology. Examples range from reports of a family with the first discovered insulin-like growth factor-2 gene mutation to a description of the first clinical trials of an ‘artificial pancreas’ in children with diabetes mellitus, along with publication of important society guidelines, such as those for management of thyroid nodules and cancer in children, the diagnosis of polycystic ovary syndrome in adolescents, and for neonatal hypoglycemia. This short review will describe some of these key developments over the past year that we believe to be of interest to pediatric endocrinologists, organized by endocrine categories.

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

Abstract: 2016-11-02T18:49:00

Cited by 468 publications

References 40 publications

A Brief Review of Hyperinsulinism in Small for Gestational Age Infants

A Brief Review of Hyperinsulinism in Small for Gestational Age Infants

Reducing Cost Through Standardization

Key Developments in Pediatric Endocrinology in 2015

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