Skip to main content
ARS Home » Plains Area » Houston, Texas » Children's Nutrition Research Center » Research » Publications at this Location » Publication #319312
Title: Recommendations from the Pediatric Endocrine Society for evaluation and management of persistent hypoglycemia in neonates, infants, and children

Author
item THORNTON, PAUL - Cook Children'S Hospital
item STANLEY, CHARLES - The Children'S Hospital Of Philadelphia
item DE LEON, DIVA - The Children'S Hospital Of Philadelphia
item HARRIS, DEBORAH - Waikato Hospital
item HAYMOND, MOREY - Children'S Nutrition Research Center (CNRC)
item HUSSAIN, KHALID - Great Ormond Street Hospital For Children
item LEVITSKY, LYNNE - Massachusetts General Hospital
item MURAD, MOHAMMAD - Mayo Clinic
item ROZANCE, PAUL - University Of Colorado
item SIMMONS, REBECCA - The Children'S Hospital Of Philadelphia
item SPERLING, MARK - University Of Pittsburgh Medical Center
item WEINSTEIN, DAVID - University Of Florida
item WHITE, NEIL - Washington University School Of Medicine
item WOLFSDORF, JOSEPH - Boston Children'S Hospital

Submitted to: Journal of Pediatrics
Publication Type: Review Article
Publication Acceptance Date: 3/31/2015
Publication Date: 8/1/2015
Citation: Thornton, P.S., Stanley, C.A., De Leon, D.D., Harris, D., Haymond, M.W., Hussain, K., Levitsky, L.L., Murad, M.H., Rozance, P.J., Simmons, R.A., Sperling, M.A., Weinstein, D.A., White, N.H., Wolfsdorf, J.I. 2015. Recommendations from the Pediatric Endocrine Society for evaluation and management of persistent hypoglycemia in neonates, infants, and children. Journal of Pediatrics. 167(2):238-245.

Interpretive Summary:

Technical Abstract: During the first 24-48 hours of life, as normal neonates transition from intrauterine to extrauterine life, their plasma glucose (PG) concentrations are typically lower than later in life. Published guidelines for screening at-risk newborns and managing low PG concentrations in neonates focus on the immediate neonatal period, but do not address the diagnosis and management of disorders causing recurrent and prolonged hypoglycemia. Distinguishing between transitional neonatal glucose regulation in normal newborns and hypoglycemia that persists or occurs for the first time beyond the first 3 days of life is important for prompt diagnosis and effective treatment to avoid serious consequences, including seizures and permanent brain injury. Moreover, the evaluation and management of pediatric hypoglycemia differ in several respects from that in adults, for whom guidelines were recently published. First, persistent hypoglycemia most often results from a congenital or genetic defect in regulating secretion of insulin, deficiency of cortisol and/or growth hormone, or defects in the metabolism of glucose, glycogen, and fatty acids. Second, it may be difficult to identify and distinguish newborn infants with a persistent hypoglycemia disorder from those with transitional low glucose levels in the initial 48 hours of life, as detailed in the separate document on transitional neonatal hypoglycemia prepared by our committee. Third, the first few months of life are the most vulnerable period for developmental disability, which occurs in ~25%-50% of children with congenital hyperinsulinism. Early recognition and treatment are crucial for preventing these sequelae. To address these deficiencies, the Pediatric Endocrine Society convened an expert panel of pediatric endocrinologists and neonatologists to develop guidelines for managing hypoglycemia in neonates, infants, and children, but excluding children with 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. The committee searched for existing evidence synthesis reports, systematic reviews, and meta-analyses. The committee also evaluated guidelines published by the Endocrine Society, American Academy of Pediatrics, Canadian Pediatric Society, and others, and reviewed their bibliographies. Committee members identified additional individual studies. The committee adopted the framework of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Working Group, in which guideline developers rate their confidence in the evidence as very low (+000), low (++00), moderate (+++0), or high (++++). Randomized trials start as high, and observational studies start as low. The guideline developers considered the quality of the evidence. They also considered the balance between benefits and harms, patients’ values and preferences, cost and resource utilization, and other societal and contextual factors, such as availability of technology and health services and implementation barriers. The recommendations according to the GRADE framework are either strong (GRADE 1), stated as "we recommend," or weak (GRADE 2), stated as "we suggest."