PT  - JOURNAL ARTICLE
AU  - Jin Ho Chong
AU  - Suresh Chandran
AU  - Prathibha Agarwal
AU  - Victor Samuel Rajadurai
TI  - Delayed presentation of prolonged hyperinsulinaemic hypoglycaemia in a preterm small-for-gestational age neonate
AID  - 10.1136/bcr-2013-200920
DP  - 2013 Dec 18
TA  - BMJ Case Reports
PG  - bcr2013200920
VI  - 2013
4099  - http://casereports.bmj.com/content/2013/bcr-2013-200920.short
4100  - http://casereports.bmj.com/content/2013/bcr-2013-200920.full
AB  - Hyperinsulinaemic hypoglycaemia in small-for-gestational age infants usually presents in the first two postnatal days. We present a preterm, small-for-gestational age infant who had hyperinsulinaemic hypoglycaemia on day 13 of life. A female twin infant weighing 1390 g was born at 32+6 weeks of gestation. Her glycaemic profile was normal till day 13 of life, after which she was noted to be lethargic and hypoglycaemic and had hyperinsulinism, hypoketonaemia and hypofattyacidaemia, requiring high glucose infusion rate to maintain normoglycaemia, while negative for septic markers and metabolic screen. Initially, there was no response to diazoxide and the genetic studies for ABCC8 and KCNJ11 gene mutations were negative. Delayed response to diazoxide was followed by complete resolution of hypoglycaemia in 5 months. This case highlights the importance of glucose monitoring in small-for-date infants for hypoglycaemia till they achieve full feeds and gain weight. Early recognition and appropriate management of hypoglycaemia in this group of infants have important implications for neurodevelopmental outcome.