Evaluation and management of neonatal onset hyperinsulinemic hypoglycemia: a single neonatal center experience

Objectives: To evaluate the clinical characteristics and treatment options of neonates requiring prolonged hospitalization due to persistent hyperinsulinemic hypoglycemia (HH). Methods: This retrospective cohort study included infants >34 weeks of gestation at birth who were born in our hospital between 2018 and 2021, diagnosed with HH, and required diazoxide within the first 28 days of life. The baseline clinical characteristics, age at the time of diagnosis and treatment options in diazoxide resistance cases were recorded. Genetic mutation analysis, if performed, was also included. Results: A total of 32 infants diagnosed with neonatal HH were followed up. Among the cohort, 25 infants were classified as having transient form of HH and seven infants were classified as having congenital hyperinsulinemic hypoglycemia (CHI). Thirty-one percent of the infants had no risk factors. The median birth weight was significantly higher in the CHI group, whereas no differences were found in other baseline characteristics. Patients diagnosed with CHI required higher glucose infusion rate, higher doses, and longer duration of diazoxide treatment than those in the transient HH group. Eight patients were resistant to diazoxide, and six of them required treatment with octreotide and finally sirolimus. Sirolimus prevented the need of pancreatectomy in five of six patients without causing major side effects. Homozygous mutations in the ABCC8 gene were found in four patients with CHI. Conclusions: The risk of persistent neonatal hyperinsulinism should be considered in hypoglycemic neonates particularly located in regions with high rates of consanguinity. Our study demonstrated sirolimus as an effective treatment option in avoiding pancreatectomy in severe cases

Demograpghic and Epidemiological Characteristics of Subacute Sclerosing Panencephalitis Patients in Pediatric Intensive Care Unit and Attitudes of Their Parents About Home Care

Introduction:Subacute sclerosing panencephalitis (SSPE) is a chronic, progressive, and degenerative infection of the central nervous system caused by measles virus. The first aim of this study was to assess the demographic and epidemiological characteristics of SSPE patients admitted to pediatric intensive care unit (PICU). The second aim was to determine the thoughts of their parents about home care.Methods:Patients with SSPE, who were admitted to our PICU between January 1, 2015 and June 30, 2015, were evaluated retrospectively.Results:Fourteen patients were admitted to the PICU for a total of 16 episodes. Ten (71%) patients were male and 4 (29%) were female. Male-to-female ratio was 2.5. The mean age of the patients was 16.25±1.14 years. Thirteen patients had received their first measles vaccine at the age of 9 months. Ten (71.4%) patients had measles infection at a later time after the vaccination and one (7.1%) patient had measles before vaccination. The mean age at the time of measles infection was 23.81±15.67 months. The mean age at the time of first symptoms was 8.64±3.33 years and the mean duration of latent period was 5.72±2.96 years. Thirteen (81.3%) patients were admitted to the PICU with pneumonia and respiratory failure, 1 (6.2%) was admitted with sepsis, and 2 (12.5%) patients were admitted with neurological problems. None of the parents accepted home care in the study period. Frequent power cuts (80%), poor housing and home conditions (70%), poverty (60%), worries of the parents about home care (60%), and household crowding (50%) were their reasons for not accepting home care.Conclusion:Patients with SSPE may require PICU admission and long PICU stays for respiratory failure and neurologic problems. Palliative care units may be an option when home care is not possible for these patients

Clinical and laboratory characteristics of patients with congenital hypothyroidism

GİRİŞ: Konjenital hipotiroidi (KH) günümüzde hala çocuklarda önlenebilir mental retardasyonun en sık sebeplerindendir. Bu çalışmada kalıcı ve geçici konjenital hipotiroidili vakaların etyolojileri, laboratuvar bulguları, tedavi dozları ve süreleri karşılaştırılmıştır. GEREÇ ve YÖNTEM: Konjenital hipotiroidi tanısı ile en az 3 yıl takip edilen 106 hasta (42 kız, 64 erkek) çalışmaya alındı. Hastaların dosyaları retrospektrif olarak tarandı. Tanı anında, tedavinin birinci, ikinci ve üçüncü yılında ve tedavi kesildikten 4-6 hafta sonra bakılan TSH, FT4, FT3, boy SDS, kilo SDS ve tedavi dozları not edildi. BULGULAR: Hastaların %41.5’inde kalıcı KH, %58.5’inde ise geçici KH saptandı. Kalıcı hipotiroidilerin en sık sebebi tiroid disgenezileri (%34) iken, geçici KH’li hastalarda en sık sebep dishormonogenezis (%38,7) idi. En sık saptanan semptomlar uzamış sarılık ve kabızlıktı. Hastaların büyük çoğunluğunu tarama testi sonucuyla polikliniğe yönlendirilen (%27.4) ve tarama testi sonucunu beklemeden rutin muayene amaçlı polikliniğimize başvuran (%27.4) hastalar oluşturmaktaydı. Gruplar arasında tanı esnasındaki serum TSH, sT4 ve sT3 seviyeleri açısından anlamlı fark yoktu (sırası ile p=0.955, p=0.532, p=0.23). Geçici KH grubunda tiroglobulin düzeyi anlamlı olarak yüksekti (p=0.026). Takiplerde kalıcı KH’li hastaların FT3 düzeyleri anlamlı ölçüde daha düşük idi. (sırasıyla p=0.003, p=0.017, p=0.032). SONUÇ: Çalışmamızda geçici KH oranının daha yüksek olduğu ve geçiçi KH’lilerin büyük çoğunluğunun dishormonogenezise bağlı olduğu görülmüştür. Tanı anındaki tiroid hormonu seviyelerinin kalıcı ve geçici KH ayırımında belirleyici olmadığı gösterilmiştir. Ancak takiplerde ihtiyaç duyulan ilaç dozunun ve TSH düzeyinin yüksek olması ve FT3 seviyesinin düşük seyretmesi kalıcı KH’yi ayırt etmede kullanılabileceği sonucuna varılmıştır.INTRODUCTION: Congenital hypothyroidism (CH) is still the most common cause of mental retardation. ln this study, etiology, laboratory findings, treatment doses, durations of permanent and transient CH cases were compared. METHODS: 106 patients (42 female, 64 male) who had been treated for CH for at least 3 years were included. Patients’ files were retrospectively scanned. TSH, FT4, FT3, height, weight and treatment doses, findings at the first time of diagnosis, first, second, and third year of treatment and 4-6 weeks after the treatment was ended, were noted. RESULTS: Permanent CH was found in 41.5% of patients and transient CH was found in 58.5% of patients. The most common cause of permanent hypothyroidism was thyroid dysgenesis (34%). dyshormonogenesis (38.7%) was the most frequent cause in patients with transient CH. The most common symptoms were hyperbilirubunemia and constipation. 27 % of the patients were referred to the outcome screening program and 27% of the patients were visited for routine control. Serum TSH, FT4 and FT3 levels at diagnosis were not significantly different between the groups (p = 0.955, p = 0.532, p = 0.23). The level of thyroglobulin was significantly higher in the transient CH group (p =0,026). FT3 levels of patients with permanent CH were significantly lower during follow-up.( p= 0.003, p = 0.017, p = 0.032). CONCLUSION: In our study, it is found that the ratio of transient CH is higher and most of the transient cases were attributed to dyshormonogenesis. It is shown that the thyroid hormone levels at the time of diagnosis is not significantly different in the differential diagnosis of permanent and transient CH. However, it is concluded that the need for higher dose in the treatment during follow up and the higher TSH levels, and the lower fT3 levels can be used in diagnosis of permanent CH