Pediatric Endocrine Society publishes guidelines for persistent hypoglycaemia

By Eleanor McDermid, Senior medwireNews Reporter

The Pediatric Endocrine Society has published guidelines for the management of persistent hypoglycaemia in neonates, infants and children without diabetes.

“The goals of these guidelines are to help physicians recognize persistent hypoglycemia disorders, guide their expeditious diagnosis and effective treatment, and prevent brain damage in at-risk babies”, say Paul Thornton (Cook Children's Medical Center, Fort Worth, Texas, USA) and co-authors.

The guidelines, which are published in The Journal of Pediatrics, cover which patients to evaluate further, what to consider during work-up of persistent hypoglycaemia and how to manage patients found to have a persistent hypoglycaemia disorder according to age and risk.

The authors recommend evaluation of children who can reliably communicate symptoms only if Whipple’s triad is noted (hypoglycaemia symptoms, low plasma glucose, response to intervention to raise glucose).

For younger children and infants, they advise further investigation only if plasma glucose is below 60 mg/dL (3.3 mmol/L) and they recommend testing neonates with a suspected high risk of a hypoglycaemia disorder when they are at least 48 hours old and therefore past the period of transitional glucose regulation.

Investigations to determine an underlying cause are advised for patients of all ages, ideally to include testing of a blood sample taken at the time of presentation, but with a fasting glucose test as an alternative and, potentially, testing of endocrine hormones and consideration of accidental drug ingestion.

The guidelines stipulate a plasma glucose treatment target of greater than 70 mg/dL (3.9 mmol/L) for neonates with a suspected congenital hypoglycaemia disorder and for infants and children with a confirmed disorder.

For high-risk neonates without a suspected congenital hypoglycaemia disorder, the authors recommend maintaining glucose levels slightly lower: above 50 mg/dL (2.8 mmol/L) for neonates younger than 48 hours and above 60 mg/dL (3.3 mmol/L) for older neonates.

The lower target for neonates without a suspected congenital disorder “was based on balancing the risks of intervention compared with a brief period of undertreatment in this group”, write Thornton et al.

“Higher treatment targets should be considered for those with a suspected genetic hypoglycemia disorder and for symptomatic neonates, because the risks of undertreatment outweigh those of overtreatment in these patients.”

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