Experience with intramuscular glucagon for infants with early neonatal hypoglycemia
-
Tatiana Smolkin
,
Joanne S. Makhoul
Abstract
Parenteral options for treating neonatal hypoglycemia (NH) include: intramuscular (i.m.) glucagon or intravenous (i.v.) glucose 10%. So far, the role of i.m. glucagon in treating NH has not been adequately assessed. We retrospectively studied 236 neonates with NH. One hundred and twenty-one infants received oral glucose-fortified-milk-based formula (OGFM) and their blood glucose level (BGL) was maintained thereafter. Two groups of infants required intervention: (a) OGFM + i.m. glucagon (n = 77, 32.6%) and (b) OGFM + i.v. glucose bolus (n = 38, 16.1%). BGL1, BGL2 and BGL3 denote pre-treatment BGL, 2–2.5 h post-treatment and BGL within 2.5–4 h post-treatment; respectively. The two groups were compared regarding two outcome measures: Outcome no. 1: BGL2 ≥ 45 mg/dL and outcome no. 2: BGL3 ≥ 45 mg/dL. Compared to i.v. glucose, the i.m. glucagon group had significantly more infants with BGL2 ≥ 45 mg/dL (40% vs. 76%, p = 0.028), and marginal significant difference regarding BGL3 ≥ 45 mg/dL (62% vs. 77%, p = 0.08). Univariate analysis showed that i.m. glucagon, male gender, vacuum extraction, cesarean delivery and one or more NH risk factors were significantly associated with outcome measure no. 1. I.m. glucagon, small for gestational age status, cesarean delivery, BGL1 and NH risk factors were associated with outcome measure no. 2. Multi-variate analysis showed that i.m. glucagon was significantly and independently associated with BGL2 ≥ 45 mg/dL. I.m. glucagon is worth consideration as a treatment option for NH.
Author contributions: Tatiana Smolkin contributed substantially to conception and design, acquisition of data, and analysis and interpretation of data; and drafting the article or revising it critically for important intellectual content; and final approval of the version to be published, and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Joanne S. Makhoul, contributed substantially to acquisition of data, or analysis and interpretation of data; and drafting the article; and final approval of the version to be published, and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Razan Elias contributed in acquisition of data, analysis and interpretation of data; and drafting the article and final approval of the version to be published, and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Fadi Farah contributed substantially to, acquisition of data, analysis and interpretation of data; and drafting the article or revising it critically for important intellectual content; and final approval of the version to be published, and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Amir Kugelman contributed substantially to conception and design, acquisition of data, or analysis and interpretation of data; and drafting the article or revising it critically for important intellectual content; and final approval of the version to be published, and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Miriam Dallashi contributed substantially to conception and design, acquisition of data, and analysis and interpretation of data; and drafting the article and revising it critically; and Final approval of the version to be published, and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Imad R. Makhoul contributed substantially to conception and design, acquisition of data, or analysis and interpretation of data; and drafting the article or revising it critically for important intellectual content; and final approval of the version to be published, and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Research funding: No financial source or nonfinancial benefits have been received or will be received from any party related directly or indirectly to the subject of this article.
Employment or leadership: None declared.
Honorarium: None declared.
Competing interests: The authors do not have any potential conflict of interest, real or perceived; this includes a description of the role of the study sponsor(s), if any, in: (1) study design; (2) the collection, analysis, and interpretation of data; (3) the writing of the report; and (4) the decision to submit the paper for publication.
Ethical statement: The study was approved by the Institutional Helsinki Ethical Committee.
References
1. Lucas A, Morley R, Cole TJ. Adverse neurodevelopmental outcome of moderate NH. Br Med J 1988; 297:1304–8.10.1136/bmj.297.6659.1304Suche in Google Scholar PubMed PubMed Central
2. Güemes M, Rahman SA, Hussain K. What is a normal blood glucose? Arch Dis Child 2016;101:569–74.10.1136/archdischild-2015-308336Suche in Google Scholar PubMed
3. Adamkin DH, Committee on Fetus and Newborn. Postnatal glucose homeostasis in late-preterm and term infants. Pediatrics 2011;127:575–9.10.1542/peds.2010-3851Suche in Google Scholar PubMed
4. Wald M, Out K, Luckner D, Simann R, Mohnike K, et al. Glucagon therapy as a possible cause of erythema necolytcum migrans in two neonates with persistent hyperinsulinemic hypoglycemia. Eur J Pediatr 2002;161:600–3.10.1007/s00431-002-1022-9Suche in Google Scholar PubMed
5. Belik J, Musey J, Trussell RA. Continuous infusion of glucagon induces severe hyponatremia and thrombocytopenia in a premature neonate. Pediatrics 2001;107:595–7.10.1542/peds.107.3.595Suche in Google Scholar PubMed
© 2019 Walter de Gruyter GmbH, Berlin/Boston
Artikel in diesem Heft
- Frontmatter
- Original Articles
- Association of the 3′UTR polymorphism (rs11665896) in the FGF21 gene with metabolic status and nutrient intake in children with obesity
- Future glycemic control of children diagnosed with type 1 diabetes mellitus at toddler and preschool/school age
- Children with type 1 diabetes of early age at onset – immune and metabolic phenotypes
- Determination of cerebral edema with serial measurement of optic nerve sheath diameter during treatment in children with diabetic ketoacidosis: a longitudinal study
- Association between inflammation, oxidative stress, vitamin D, copper and zinc with pre-obesity and obesity in school children from the city of Podgorica, Montenegro
- Phenotypic diversity and correlation with the genotypes of pseudohypoaldosteronism type 1
- Start low, go slowly – mental abnormalities in young prolactinoma patients under cabergoline therapy
- Primary ovarian insufficiency in an adolescent population: clinical phenotype and diagnostic approach
- Novel combined insulin-like 3 variations of a single nucleotide in cryptorchidism
- Evaluation of the abdominopelvic region using MRI in patients with primary amenorrhea
- Benefits of aerobic training in girls with precocious puberty: involvement of CRP and cortisol
- The relationship between the olfactory bulb and precocious puberty: from the nose to the pituitary
- Short Communication
- Experience with intramuscular glucagon for infants with early neonatal hypoglycemia
- Case Reports
- A novel GATA6 variant in a boy with neonatal diabetes and diaphragmatic hernia: a familial case with a review of the literature
- Nephrogenic diabetes insipidus in a 15-year-old Hispanic female with a novel AQP2 mutation
- Pediatric stroke as the presenting symptom of new-onset type 1 diabetes mellitus without DKA: case report and literature review
- Panhypopituitarism from neurosarcoidosis in an adolescent: case report and literature review
Artikel in diesem Heft
- Frontmatter
- Original Articles
- Association of the 3′UTR polymorphism (rs11665896) in the FGF21 gene with metabolic status and nutrient intake in children with obesity
- Future glycemic control of children diagnosed with type 1 diabetes mellitus at toddler and preschool/school age
- Children with type 1 diabetes of early age at onset – immune and metabolic phenotypes
- Determination of cerebral edema with serial measurement of optic nerve sheath diameter during treatment in children with diabetic ketoacidosis: a longitudinal study
- Association between inflammation, oxidative stress, vitamin D, copper and zinc with pre-obesity and obesity in school children from the city of Podgorica, Montenegro
- Phenotypic diversity and correlation with the genotypes of pseudohypoaldosteronism type 1
- Start low, go slowly – mental abnormalities in young prolactinoma patients under cabergoline therapy
- Primary ovarian insufficiency in an adolescent population: clinical phenotype and diagnostic approach
- Novel combined insulin-like 3 variations of a single nucleotide in cryptorchidism
- Evaluation of the abdominopelvic region using MRI in patients with primary amenorrhea
- Benefits of aerobic training in girls with precocious puberty: involvement of CRP and cortisol
- The relationship between the olfactory bulb and precocious puberty: from the nose to the pituitary
- Short Communication
- Experience with intramuscular glucagon for infants with early neonatal hypoglycemia
- Case Reports
- A novel GATA6 variant in a boy with neonatal diabetes and diaphragmatic hernia: a familial case with a review of the literature
- Nephrogenic diabetes insipidus in a 15-year-old Hispanic female with a novel AQP2 mutation
- Pediatric stroke as the presenting symptom of new-onset type 1 diabetes mellitus without DKA: case report and literature review
- Panhypopituitarism from neurosarcoidosis in an adolescent: case report and literature review
