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Transient neonatal hyperinsulinaemic hypoglycaemia: perinatal predictors of length and cost of stay

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Abstract

Admission to neonatal care causes separation of infants from their parents, can adversely affect breast-feeding and is associated with painful procedures. Our aim was to identify perinatal factors and cost of care associated with transient neonatal hyperinsulinaemic hypoglycaemia (HH). Infants born after 35 weeks of gestation admitted because of hypoglycaemia were studied. The neonates were divided into two groups (HH and non-HH), and their length and cost of care were compared and perinatal factors predicting those outcomes explored. Forty of the 474 infants admitted with hypoglycaemia were diagnosed with HH. The HH group had a lower median (IQR) glucose level on admission compared to the non-HH group (p < 0.001). The median (IQR) cost of stay was higher in the HH group (p < 0.001). In the HH group, the GIRmax was significantly correlated with cost of stay (p < 0.001). GIRmax predicted a cost of stay > £9140 with an area under the ROC curve of 0.956. GIRmax > 13.9 mg/kg/min predicted admission cost > £9140 with 86% sensitivity and 93% specificity.

Conclusion: Transient neonatal HH was associated with a higher length and cost of stay in infants admitted for hypoglycaemia. The GIRmax can predict the length and cost of stay.

What is Known:

• Neonatal hypoglycaemia is the leading cause of term and late preterm neonatal admissions.

• Hyperinsulinism (HH) is the commonest cause of persistent hypoglycaemia, and delay in the diagnosis and management can have a detrimental impact on long-term development.

What is New:

• We have demonstrated prior to NICU admission that blood glucose concentrations were lower in infants with HH compared to those without.

• The maximum GIR had a stronger correlation with total length and cost of hospital stay compared to insulin levels in HH infants.

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Abbreviations

AUC:

Area under the curve

BMI:

Body mass index

CTG:

Cardiotocograph

FGR:

Foetal growth restriction

GDM:

Gestational diabetes mellitus

GIRmax :

Maximum glucose infusion rate

HH:

Hyperinsulinaemic hypoglycaemia

IQR:

Interquartile range

NICU:

Neonatal intensive care unit

OGTT:

Oral glucose tolerance test

ROC:

Receiver operator characteristic curve

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Funding

The research was supported by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Guy’s and St Thomas’ NHS Foundation Trust and King’s College London. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

Author information

Authors and Affiliations

  1. Neonatal Intensive Care Centre, King’s College Hospital NHS Foundation Trust, London, UK

    Kazune Kozen & Theodore Dassios

  2. Harris Birthright Centre for Fetal Medicine, King’s College Hospital NHS Foundation Trust, London, UK

    Nick Kametas

  3. Paediatric Endocrinology, King’s College Hospital NHS Foundation Trust, London, UK

    Ritika R. Kapoor

  4. MRC-Asthma UK Centre in Allergic Mechanisms of Asthma, King’s College London, London, UK

    Anne Greenough

  5. Women and Children’s Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, UK

    Anne Greenough

  6. National Institute for Health Research (NIHR) Biomedical Research Centre based at Guy’s and St Thomas’ NHS Foundation Trust and King’s College London, London, UK

    Anne Greenough

Authors
  1. Kazune Kozen
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  2. Theodore Dassios
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  3. Nick Kametas
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  4. Ritika R. Kapoor
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  5. Anne Greenough
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Contributions

KK collected the data, participated in the analysis of the data and drafted the first version of the article. TD conceived the study, participated in the analysis of the data and contributed to writing the manuscript. NK contributed the antenatal maternal data, calculated the z-scores and approved the last version of the manuscript. RK contributed to the design of the study and critically appraised the manuscript. AG supervised the project, contributed to the study design and interpretation of the results and critically revised the manuscript. All authors were involved in the preparation of the manuscript, critically reviewed the manuscript and approved the final manuscript as submitted.

Corresponding author

Correspondence to Anne Greenough.

Ethics declarations

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Infants whose parents gave informed written consent were recruited.

Additional information

Communicated by Patrick Van Reempts

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Kozen, K., Dassios, T., Kametas, N. et al. Transient neonatal hyperinsulinaemic hypoglycaemia: perinatal predictors of length and cost of stay. Eur J Pediatr 177, 1823–1829 (2018). https://doi.org/10.1007/s00431-018-3242-7

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  • DOI: https://doi.org/10.1007/s00431-018-3242-7

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