Abstract

Research Article

Maltodextrin Use in Persistent Neonatal Hypoglycemia; Audit Report of a Single Center Experience

Brijroy Viswanathan*, Adnan Al Sayed, Lina Habboub, Meera Al Mohannadi, Lolwa Alobaidan and Muneera Abdulmohsin

Published: 27 December, 2023 | Volume 6 - Issue 2 | Pages: 046-050

Background: Neonatal hypoglycemia is known to cause significant neuronal damage and poor neurodevelopmental outcomes. Consensus guidelines are lacking for the management of persistent neonatal hypoglycemia and hyperinsulinism which often requires high concentrations of dextrose and medications. Although used in the pediatric population with persistent hypoglycemia, only a few case reports are published regarding the use of Maltodextrin supplementation in persistent neonatal hypoglycemia due to transient hyperinsulinism. 
Objective: To audit the use of Maltodextrins in the management of persistent neonatal hypoglycemia due to transient hyperinsulinism in neonates. 
Audit design: A retrospective chart review (CERNER electronic data) of all cases with persistent neonatal hypoglycemia who received Maltodextrin supplementation for a period of 3½ years between July 2018 and December 2021. 
Results: A total of 18 neonates received Maltodextrin supplementation for neonatal hypoglycemia during the audit period. 16/18 (89%) neonates who received Maltodextrin supplementation were weaned off from intravenous dextrose within 1 week without major side effects or severe rebound hypoglycemia. Two out of 18 babies who received Maltodextrin needed Diazoxide supplementation for persistent hypoglycemia.  
Conclusion: The results of our audit are promising, yet further research and randomized controlled studies are needed to systematically evaluate the findings of this audit regarding Maltodextrin supplementation for the management of neonatal hypoglycemia with transient hyperinsulinism.

Read Full Article HTML DOI: 10.29328/journal.japch.1001060 Cite this Article Read Full Article PDF

Keywords:

Neonatal hypoglycemia; Hyperinsulinism; Maltodextrin; Oligosaccharide; Starch supplementation

References

  1. Adamkin DH. Neonatal hypoglycemia. Curr Opin Pediatr. 2016 Apr;28(2):150-5. doi: 10.1097/MOP.0000000000000319. PMID: 26780301.
  2. Sweet CB, Grayson S, Polak M. Management strategies for neonatal hypoglycemia. J Pediatr Pharmacol Ther. 2013 Jul;18(3):199-208. doi: 10.5863/1551-6776-18.3.199. PMID: 24052783; PMCID: PMC3775554.
  3. Rozance PJ, Hay WW Jr. New approaches to management of neonatal hypoglycemia. Matern Health Neonatol Perinatol. 2016 May 10;2:3. doi: 10.1186/s40748-016-0031-z. PMID: 27168942; PMCID: PMC4862061.
  4. Thornton PS, Stanley CA, De Leon DD, Harris D, Haymond MW, Hussain K, Levitsky LL, Murad MH, Rozance PJ, Simmons RA, Sperling MA, Weinstein DA, White NH, Wolfsdorf JI; Pediatric Endocrine Society. Recommendations from the Pediatric Endocrine Society for Evaluation and Management of Persistent Hypoglycemia in Neonates, Infants, and Children. J Pediatr. 2015 Aug;167(2):238-45. doi: 10.1016/j.jpeds.2015.03.057. Epub 2015 May 6. PMID: 25957977.
  5. Solimano A. Drop that calculator! You can easily calculate the glucose infusion rate in your head, and should! Paediatr Child Health. 2020 Jun;25(4):199-200. doi: 10.1093/pch/pxz115. Epub 2019 Oct 9. PMID: 32549731; PMCID: PMC7286731.
  6. Chou JY, Jun HS, Mansfield BC. Glycogen storage disease type I and G6Pase-β deficiency: etiology and therapy. Nat Rev Endocrinol. 2010 Dec;6(12):676-88. doi: 10.1038/nrendo.2010.189. Epub 2010 Oct 26. PMID: 20975743; PMCID: PMC4178929.
  7. Demirbilek H, Hussain K. Congenital Hyperinsulinism: Diagnosis and Treatment Update. J Clin Res Pediatr Endocrinol. 2017 Dec 30;9(Suppl 2):69-87. doi: 10.4274/jcrpe.2017.S007. Epub 2017 Dec 27. PMID: 29280746; PMCID: PMC5790328.
  8. Mehta S, Brar PC. Severe, persistent neonatal hypoglycemia as a presenting feature in patients with congenital hypopituitarism: a review of our case series. J Pediatr Endocrinol Metab. 2019 Jul 26;32(7):767-774. doi: 10.1515/jpem-2019-0075. PMID: 31211689.
  9. Group of Neonatology, Pediatric Society, Chinese Medical Association. Expert consensus on standard clinical management of neonatal hypoglycemia in China (2021). Zhongguo Dang Dai Er Ke Za Zhi. 2022 Jan 15;24(1):1-13. English, Chinese. doi: 10.7499/j.issn.1008-8830.2108061. PMID: 35177170; PMCID: PMC8802387.
  10. Yap F, Högler W, Vora A, Halliday R, Ambler G. Severe transient hyperinsulinaemic hypoglycaemia: two neonates without predisposing factors and a review of the literature. Eur J Pediatr. 2004 Jan;163(1):38-41. doi: 10.1007/s00431-003-1328-2. Epub 2003 Oct 29. PMID: 14586649.
  11. Edwards T, Harding JE. Clinical Aspects of Neonatal Hypoglycemia: A Mini Review. Front Pediatr. 2021 Jan 8;8:562251. doi: 10.3389/fped.2020.562251. PMID: 33489995; PMCID: PMC7820332.
  12. Levene I, Wilkinson D. Identification and management of neonatal hypoglycaemia in the full-term infant (British Association of Perinatal Medicine-Framework for Practice). Arch Dis Child Educ Pract Ed. 2019 Feb;104(1):29-32. doi: 10.1136/archdischild-2017-314050. Epub 2018 Jun 14. PMID: 29903743.
  13. Rozance PJ, Wolfsdorf JI. Hypoglycemia in the Newborn. Pediatr Clin North Am. 2019 Apr;66(2):333-342. doi: 10.1016/j.pcl.2018.12.004. Epub 2019 Feb 1. PMID: 30819340.
  14. Ball SG, Iqbal Z. Diagnosis and treatment of hyponatraemia. Best Pract Res Clin Endocrinol Metab. 2016 Mar;30(2):161-73. doi: 10.1016/j.beem.2015.12.001. Epub 2015 Dec 30. PMID: 27156756.
  15. Shaikh MG, Lucas-Herald AK, Dastamani A, Salomon Estebanez M, Senniappan S, Abid N, Ahmad S, Alexander S, Avatapalle B, Awan N, Blair H, Boyle R, Chesover A, Cochrane B, Craigie R, Cunjamalay A, Dearman S, De Coppi P, Erlandson-Parry K, Flanagan SE, Gilbert C, Gilligan N, Hall C, Houghton J, Kapoor R, McDevitt H, Mohamed Z, Morgan K, Nicholson J, Nikiforovski A, O'Shea E, Shah P, Wilson K, Worth C, Worthington S, Banerjee I. Standardised practices in the networked management of congenital hyperinsulinism: a UK national collaborative consensus. Front Endocrinol (Lausanne). 2023 Oct 30;14:1231043. doi: 10.3389/fendo.2023.1231043. PMID: 38027197; PMCID: PMC10646160.
  16. Writers AM. Manage congenital hyperinsulinism with pharmacotherapy and nutritional therapy based on its form, severity and response. Drugs and Therapy Perspectives. 2020; 36(3):106–11.
  17. Denkboy Öngen Y, Eren E, Sağlam H. Maltodextrin May Be a Promising Treatment Modality After Near-total Pancreatectomy in Infants Younger Than Six Months with Persistent Hyperinsulinism: A Case Report. J Clin Res Pediatr Endocrinol. 2023 Feb 27;15(1):103-107. doi: 10.4274/jcrpe.galenos.2021.2021.0121. Epub 2021 Sep 3. PMID: 34477356; PMCID: PMC9976159.
  18. Module GP. Polycose ® Product Information : Polycose ® Polycose ®. 2013; 1–4.
  19. Della Pepa G, Vetrani C, Lupoli R, Massimino E, Lembo E, Riccardi G, Capaldo B. Uncooked cornstarch for the prevention of hypoglycemic events. Crit Rev Food Sci Nutr. 2022;62(12):3250-3263. doi: 10.1080/10408398.2020.1864617. Epub 2021 Jan 18. PMID: 33455416.
  20. Hofman DL, van Buul VJ, Brouns FJ. Nutrition, Health, and Regulatory Aspects of Digestible Maltodextrins. Crit Rev Food Sci Nutr. 2016 Sep 9;56(12):2091-100. doi: 10.1080/10408398.2014.940415. PMID: 25674937; PMCID: PMC4940893.
  21. Cresto JC, Abdenur JP, Bergada I, Martino R. Long-term follow up of persistent hyperinsulinaemic hypoglycaemia of infancy. Arch Dis Child. 1998 Nov;79(5):440-4. doi: 10.1136/adc.79.5.440. PMID: 10193260; PMCID: PMC1717747.
  22. De Cosio AP, Thornton P. Current and Emerging Agents for the Treatment of Hypoglycemia in Patients with Congenital Hyperinsulinism. Paediatr Drugs. 2019 Jun;21(3):123-136. doi: 10.1007/s40272-019-00334-w. PMID: 31218604.
  23. Blanco M, Khan O, Stanley K, Hageman JR, Greeley SA. Hyperinsulinism in a neonate. Pediatr Ann. 2014 Mar;43(3):e56-60. doi: 10.3928/00904481-20140221-08. PMID: 24605860; PMCID: PMC4753077.
  24. Harding JE, Hegarty JE, Crowther CA, Edlin RP, Gamble GD, Alsweiler JM; hPOD Study Group. Evaluation of oral dextrose gel for prevention of neonatal hypoglycemia (hPOD): A multicenter, double-blind randomized controlled trial. PLoS Med. 2021 Jan 28;18(1):e1003411. doi: 10.1371/journal.pmed.1003411. PMID: 33507929; PMCID: PMC7842885.

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