Newborn Persistent Hypoglycemia Clinical Pathway — N/IICU

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Goals and Metrics

Patient Education

Provider Resources

Related Pathway

Glucose Monitoring in the
Healthy Newborn, Inpatient

Newborn with Persistent Hypoglycemia

Glucose < 50 mg/dL from random glucose test or diagnostic fast
- Obtain Critical Fasting Labs
- Then perform Glucagon Stimulation Test
Check Newborn Screen
Consult Endocrinology
Review
- Differential Diagnosis of Persistent Hypoglycemia
- Metabolic Diseases and Endocrine Disorders

Interpretation of Lab Results

Consult Metabolism for
Suspected Metabolic Disease

Suspected Hyperinsulinism

HI Diagnostic criteria when glucose < 50 mg/dL
- Detectable insulin > 2 mIU/mL
- Low beta-hydroxybutyrate < 1.8 mmol/L
- Low free fatty acids < 1.7 mmol/L

Etiologies of HI
Medications: Diazoxide, Glucagon infusion
Additional Evaluation Considerations
- Genetic Consultation, genetic testing
- Cardiology Consultation

Treatment:
- 5 Day Trial of Diazoxide
- Start chlorothiazide
Treatment Goal:
- Maintain euglycemia, glucose > 70 mg/dL for infants > 72 hrs of life

Fasting Test
- On Diazoxide off IVF
- Goal: Fasting time 6-12 hrs with plasma glucose maintained > 70

Fails Fast

Tolerates Fast

Diazoxide unresponsiveness suggests a K_ATP channel HI and potential surgical candidate
Send expedited genetic testing of ABCC8 and KCNJ11
Discontinue diazoxide
Maintain plasma glucose above 70 mg/dL with dextrose containing IVF
Consider central line placement to give higher dextrose concentration in IVF
Consider continuous glucagon infusion (1 mg/day) if fluid overload is a concern
Arrange transfer to CHOP for further care
and potential 18F-DOPA PET

Continue diazoxide with glucose monitoring
Obtain ECHO, CBC with diff, and BMP 1 week after starting diazoxide or prior to discharge
Send comprehensive HI genetic testing
Discharge Planning with Endocrinology

Posted: September 2016
Revised: May 2023

Authors:
- D. De León, MD;
- C. Stanley, MD;
- R. Simmons, MD;
- K. Wade, MD;
- C. Ficicioglu, MD;
- K. Lord, MD;
- S. Ghavam, MD;
- A. Bustin, PharmD;
- S. Gattoline, PharmD

Editors: Clinical Pathways Team

Evidence

CHOP Program

Congenital Hyperinsulinism Center

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N/IICU Clinical Pathway for Evaluation/Treatment of Persistent Hypoglycemia in the Newborn

Evidence

CHOP Program

N/IICU Clinical Pathway for Evaluation/Treatment
of Persistent Hypoglycemia in the Newborn