Persistent neonatal hypoglycaemia: a clinical case treated with octreotide

Abstract

Neonatal hyperinsulinism is the most common form of persistent hypoglycaemia during the first year of life. There is an inappropriate oversecretion of insulin in the presence of hypoglycaemia due to a dysfunction of the sulphonylurea receptor in the pancreatic beta-cell. We describe a case of a premature neonate, small for dates, who presented early hypoglycaemia which was difficult to manage, requiring glucose infusional rates of up to 26 mg/kg/min. When the diagnosis was confirmed, medical treatment with octreotide was started. After 72 hours of treatment it was possible to decrease the glucose infusion, which was discontinued at 6 weeks. The follow up of the patient did not reveal any adverse effects, his nutritional condition is adequate and his psychomotor development is normal. The use of octreotide should be considered as an alternative treatment for a child with persistent hyperinsulinism, avoiding the need for surgery which has a high morbidity in this age group.