A Newborn With Severe and Refractory Hypoglycemia

Abstract

Hypoglycemia is a common entity encountered in the neonatal population with identified risk factors. Severe symptomatic hypoglycemia in a term baby without any specific risk factors is rare. The management includes identifying the underlying etiology which involves a “critical sample” and its interpretation. Hyperinsulinism (HI) detected during assessment is often transient and may be prolonged and difficult to treat. It is challenging to differentiate transient from persistent HI but becomes essential when effective medical or definitive surgical treatment has to be considered in especially refractory cases. The crucial task of maintaining normoglycemia demands continuous monitoring and proactive planned management as literature shows adverse neurodevelopmental outcomes in babies with even short-lasting transient HI due to hypoglycemic events that can be severe. This translates into these newborns being subjected to multiple noxious stimuli and distinct reactions to pain. Our approach to a newborn with congenital HI involved complex medical strategies with continuous glucose monitoring with an in situ subcutaneously placed detector before definitive surgical management at 8 months of life.