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Kaiser JR, Amatya S, Burke RJ, Corr TE, Darwish N, Gandhi CK, Gasda A, Glass KM, Kresch MJ, Mahdally SM, McGarvey MT, Mola SJ, Murray YL, Nissly K, Santiago-Aponte NM, Valencia JC, Palmer TW. Proposed Screening for Congenital Hyperinsulinism in Newborns: Perspective from a Neonatal-Perinatal Medicine Group. J Clin Med 2024; 13:2953. [PMID: 38792494 PMCID: PMC11122587 DOI: 10.3390/jcm13102953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 05/14/2024] [Accepted: 05/15/2024] [Indexed: 05/26/2024] Open
Abstract
This perspective work by academic neonatal providers is written specifically for the audience of newborn care providers and neonatologists involved in neonatal hypoglycemia screening. Herein, we propose adding a screen for congenital hyperinsulinism (CHI) by measuring glucose and ketone (i.e., β-hydroxybutyrate (BOHB)) concentrations just prior to newborn hospital discharge and as close to 48 h after birth as possible, at the same time that the mandated state Newborn Dried Blood Spot Screen is obtained. In the proposed protocol, we do not recommend specific metabolite cutoffs, as our primary objective is to simply highlight the concept of screening for CHI in newborns to newborn caregivers. The premise for our proposed screen is based on the known effect of hyperinsulinism in suppressing ketogenesis, thereby limiting ketone production. We will briefly discuss genetic CHI, other forms of neonatal hypoglycemia, and their shared mechanisms; the mechanism of insulin regulation by functional pancreatic islet cell membrane KATP channels; adverse neurodevelopmental sequelae and brain injury due to missing or delaying the CHI diagnosis; the principles of a good screening test; how current neonatal hypoglycemia screening programs do not fulfill the criteria for being effective screening tests; and our proposed algorithm for screening for CHI in newborns.
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Affiliation(s)
- Jeffrey R. Kaiser
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Penn State Health Children’s Hospital, Hershey, PA 17033, USA; (S.A.); (R.J.B.); (T.E.C.); (N.D.); (C.K.G.); (A.G.); (K.M.G.); (M.J.K.); (S.M.M.); (M.T.M.); (S.J.M.); (Y.L.M.); (K.N.); (N.M.S.-A.); (J.C.V.); (T.W.P.)
- Department of Obstetrics and Gynecology, Penn State Milton S. Hershey Medical Center, Hershey, PA 17033, USA
| | - Shaili Amatya
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Penn State Health Children’s Hospital, Hershey, PA 17033, USA; (S.A.); (R.J.B.); (T.E.C.); (N.D.); (C.K.G.); (A.G.); (K.M.G.); (M.J.K.); (S.M.M.); (M.T.M.); (S.J.M.); (Y.L.M.); (K.N.); (N.M.S.-A.); (J.C.V.); (T.W.P.)
| | - Rebecca J. Burke
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Penn State Health Children’s Hospital, Hershey, PA 17033, USA; (S.A.); (R.J.B.); (T.E.C.); (N.D.); (C.K.G.); (A.G.); (K.M.G.); (M.J.K.); (S.M.M.); (M.T.M.); (S.J.M.); (Y.L.M.); (K.N.); (N.M.S.-A.); (J.C.V.); (T.W.P.)
| | - Tammy E. Corr
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Penn State Health Children’s Hospital, Hershey, PA 17033, USA; (S.A.); (R.J.B.); (T.E.C.); (N.D.); (C.K.G.); (A.G.); (K.M.G.); (M.J.K.); (S.M.M.); (M.T.M.); (S.J.M.); (Y.L.M.); (K.N.); (N.M.S.-A.); (J.C.V.); (T.W.P.)
| | - Nada Darwish
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Penn State Health Children’s Hospital, Hershey, PA 17033, USA; (S.A.); (R.J.B.); (T.E.C.); (N.D.); (C.K.G.); (A.G.); (K.M.G.); (M.J.K.); (S.M.M.); (M.T.M.); (S.J.M.); (Y.L.M.); (K.N.); (N.M.S.-A.); (J.C.V.); (T.W.P.)
| | - Chintan K. Gandhi
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Penn State Health Children’s Hospital, Hershey, PA 17033, USA; (S.A.); (R.J.B.); (T.E.C.); (N.D.); (C.K.G.); (A.G.); (K.M.G.); (M.J.K.); (S.M.M.); (M.T.M.); (S.J.M.); (Y.L.M.); (K.N.); (N.M.S.-A.); (J.C.V.); (T.W.P.)
| | - Adrienne Gasda
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Penn State Health Children’s Hospital, Hershey, PA 17033, USA; (S.A.); (R.J.B.); (T.E.C.); (N.D.); (C.K.G.); (A.G.); (K.M.G.); (M.J.K.); (S.M.M.); (M.T.M.); (S.J.M.); (Y.L.M.); (K.N.); (N.M.S.-A.); (J.C.V.); (T.W.P.)
| | - Kristen M. Glass
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Penn State Health Children’s Hospital, Hershey, PA 17033, USA; (S.A.); (R.J.B.); (T.E.C.); (N.D.); (C.K.G.); (A.G.); (K.M.G.); (M.J.K.); (S.M.M.); (M.T.M.); (S.J.M.); (Y.L.M.); (K.N.); (N.M.S.-A.); (J.C.V.); (T.W.P.)
| | - Mitchell J. Kresch
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Penn State Health Children’s Hospital, Hershey, PA 17033, USA; (S.A.); (R.J.B.); (T.E.C.); (N.D.); (C.K.G.); (A.G.); (K.M.G.); (M.J.K.); (S.M.M.); (M.T.M.); (S.J.M.); (Y.L.M.); (K.N.); (N.M.S.-A.); (J.C.V.); (T.W.P.)
| | - Sarah M. Mahdally
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Penn State Health Children’s Hospital, Hershey, PA 17033, USA; (S.A.); (R.J.B.); (T.E.C.); (N.D.); (C.K.G.); (A.G.); (K.M.G.); (M.J.K.); (S.M.M.); (M.T.M.); (S.J.M.); (Y.L.M.); (K.N.); (N.M.S.-A.); (J.C.V.); (T.W.P.)
| | - Maria T. McGarvey
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Penn State Health Children’s Hospital, Hershey, PA 17033, USA; (S.A.); (R.J.B.); (T.E.C.); (N.D.); (C.K.G.); (A.G.); (K.M.G.); (M.J.K.); (S.M.M.); (M.T.M.); (S.J.M.); (Y.L.M.); (K.N.); (N.M.S.-A.); (J.C.V.); (T.W.P.)
| | - Sara J. Mola
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Penn State Health Children’s Hospital, Hershey, PA 17033, USA; (S.A.); (R.J.B.); (T.E.C.); (N.D.); (C.K.G.); (A.G.); (K.M.G.); (M.J.K.); (S.M.M.); (M.T.M.); (S.J.M.); (Y.L.M.); (K.N.); (N.M.S.-A.); (J.C.V.); (T.W.P.)
| | - Yuanyi L. Murray
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Penn State Health Children’s Hospital, Hershey, PA 17033, USA; (S.A.); (R.J.B.); (T.E.C.); (N.D.); (C.K.G.); (A.G.); (K.M.G.); (M.J.K.); (S.M.M.); (M.T.M.); (S.J.M.); (Y.L.M.); (K.N.); (N.M.S.-A.); (J.C.V.); (T.W.P.)
| | - Katie Nissly
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Penn State Health Children’s Hospital, Hershey, PA 17033, USA; (S.A.); (R.J.B.); (T.E.C.); (N.D.); (C.K.G.); (A.G.); (K.M.G.); (M.J.K.); (S.M.M.); (M.T.M.); (S.J.M.); (Y.L.M.); (K.N.); (N.M.S.-A.); (J.C.V.); (T.W.P.)
| | - Nanyaly M. Santiago-Aponte
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Penn State Health Children’s Hospital, Hershey, PA 17033, USA; (S.A.); (R.J.B.); (T.E.C.); (N.D.); (C.K.G.); (A.G.); (K.M.G.); (M.J.K.); (S.M.M.); (M.T.M.); (S.J.M.); (Y.L.M.); (K.N.); (N.M.S.-A.); (J.C.V.); (T.W.P.)
| | - Jazmine C. Valencia
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Penn State Health Children’s Hospital, Hershey, PA 17033, USA; (S.A.); (R.J.B.); (T.E.C.); (N.D.); (C.K.G.); (A.G.); (K.M.G.); (M.J.K.); (S.M.M.); (M.T.M.); (S.J.M.); (Y.L.M.); (K.N.); (N.M.S.-A.); (J.C.V.); (T.W.P.)
| | - Timothy W. Palmer
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Penn State Health Children’s Hospital, Hershey, PA 17033, USA; (S.A.); (R.J.B.); (T.E.C.); (N.D.); (C.K.G.); (A.G.); (K.M.G.); (M.J.K.); (S.M.M.); (M.T.M.); (S.J.M.); (Y.L.M.); (K.N.); (N.M.S.-A.); (J.C.V.); (T.W.P.)
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Alam KA, Svalastoga P, Martinez A, Glennon JC, Haavik J. Potassium channels in behavioral brain disorders. Molecular mechanisms and therapeutic potential: A narrative review. Neurosci Biobehav Rev 2023; 152:105301. [PMID: 37414376 DOI: 10.1016/j.neubiorev.2023.105301] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/26/2023] [Accepted: 06/30/2023] [Indexed: 07/08/2023]
Abstract
Potassium channels (K+-channels) selectively control the passive flow of potassium ions across biological membranes and thereby also regulate membrane excitability. Genetic variants affecting many of the human K+-channels are well known causes of Mendelian disorders within cardiology, neurology, and endocrinology. K+-channels are also primary targets of many natural toxins from poisonous organisms and drugs used within cardiology and metabolism. As genetic tools are improving and larger clinical samples are being investigated, the spectrum of clinical phenotypes implicated in K+-channels dysfunction is rapidly expanding, notably within immunology, neurosciences, and metabolism. K+-channels that previously were considered to be expressed in only a few organs and to have discrete physiological functions, have recently been found in multiple tissues and with new, unexpected functions. The pleiotropic functions and patterns of expression of K+-channels may provide additional therapeutic opportunities, along with new emerging challenges from off-target effects. Here we review the functions and therapeutic potential of K+-channels, with an emphasis on the nervous system, roles in neuropsychiatric disorders and their involvement in other organ systems and diseases.
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Affiliation(s)
| | - Pernille Svalastoga
- Mohn Center for Diabetes Precision Medicine, Department of Clinical Science, University of Bergen, Bergen, Norway; Children and Youth Clinic, Haukeland University Hospital, Bergen, Norway
| | | | - Jeffrey Colm Glennon
- Conway Institute for Biomolecular and Biomedical Research, School of Medicine, University College Dublin, Dublin, Ireland.
| | - Jan Haavik
- Department of Biomedicine, University of Bergen, Norway; Division of Psychiatry, Haukeland University Hospital, Norway.
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Саракаева ЛР, Рыжкова ДВ, Митрофанова ЛБ, Баиров ВГ, Сухоцкая АА, Смородин АП, Ефтич ЕА, Кельмансон ИА, Никитина ИЛ. [Electroencephalogram features in children with congenital hyperinsulinism treated according to the international protocol in Russian Federation]. PROBLEMY ENDOKRINOLOGII 2023; 69:68-75. [PMID: 36842080 PMCID: PMC9978872 DOI: 10.14341/probl13174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/03/2022] [Indexed: 02/27/2023]
Abstract
BACKGROUND Congenital hyperinsulinism (CHI) is a rare life-threatening disease characterised by persistent hypoglycaemia as a result of inappropriate insulin secretion, which can lead to irreversible neurological defects in infants. AIM To evaluate neurophysiological characteristics of central nervous system in children with congenital hyperinsulinism treated according to the international protocol in Russian Federation. MATERIALS AND METHODS Our retrospective, prospective cohort study included 73 patients who received treatment for CHI according to the current international protocol at different departments of the Almazov National Medical Research Centre from 2017 to 2022. All patients underwent a comprehensive examination, including electroencephalography (EEG). RESULTS Among 73 patients with CHI, 35% (23) had focal form of the disease, 65% had non-focal form (49% (39) - diffuse form, 16% (11) - atypical form). All patients with focal form of CHI had a recovery as an outcome.Analysing the EEG data we found that paroxysmal activity was recorded in 23 patients (32%), 50 patients did not have paroxysmal activity (68%). Diffuse changes were observed in 47 patients (64%), whereas 26 patients (36%) were absent of it. By constructing Kaplan-Meier curves we found that the alpha rhythm is formed significantly (p=0.026) earlier in patients with a focal form of CHI. CONCLUSION CHI patients treated according to the international guidelines in Russian Federation show rather positive neurological outcome. We established that alpha rhythm earliest formation is associated with focal form of CHI.
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Affiliation(s)
- Л. Р. Саракаева
- Национальный медицинский исследовательский центр им. В.А. Алмазова
| | - Д. В. Рыжкова
- Национальный медицинский исследовательский центр им. В.А. Алмазова
| | | | - В. Г. Баиров
- Национальный медицинский исследовательский центр им. В.А. Алмазова
| | - А. А. Сухоцкая
- Национальный медицинский исследовательский центр им. В.А. Алмазова
| | - А. П. Смородин
- Национальный медицинский исследовательский центр им. В.А. Алмазова
| | - Е. А. Ефтич
- Национальный медицинский исследовательский центр им. В.А. Алмазова
| | - И. А. Кельмансон
- Национальный медицинский исследовательский центр им. В.А. Алмазова
| | - И. Л. Никитина
- Национальный медицинский исследовательский центр им. В.А. Алмазова
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Boskabadi SJ, Ramezaninejad S, Sohrab M, Farhadi R. Diazoxide-Induced Hypertrichosis in a Neonate With Transient Hyperinsulinism. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2023; 16:11795476231151330. [PMID: 36726424 PMCID: PMC9885027 DOI: 10.1177/11795476231151330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 12/28/2022] [Indexed: 01/28/2023]
Abstract
Diazoxide is one of the FDA-approved pharmacologic treatments for hyperinsulinemic hypoglycemia, however, its adverse effects in infants are not well described. We reported a 37-week-old boy with the diagnosis of hypoglycemia. We started a dextrose infusion, but we used oral diazoxide, due to hypoglycemia episodes despite the increase in dextrose intake. The newborn had a normoglycemic condition after gradually increasing the diazoxide dose to 15 mg/kg/day. He was fully breastfed and discharged at 14 days of age with ongoing diazoxide. In weekly serial clinical follow-ups, the parents noticed an increase in the growth of forehead and facial hair that was diagnosed as diazoxide-induced hypertrichosis. Diazoxide was gradually tapered, and hypertrichosis continued until 1 month after dioxide discontinuation. Diazoxide use in NICU settings has increased over time. Diazoxide has many side effects, one of which is hypertrichosis. Many diazoxide side effects have been reported in adults or children and few studies have reported the prevalence of these adverse effects of diazoxide in neonates and infants.
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Affiliation(s)
- Seyyed Javad Boskabadi
- Department of Clinical Pharmacy,
Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Sima Ramezaninejad
- Department of Clinical Pharmacy,
Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Masoumeh Sohrab
- Department of Clinical Pharmacy,
Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Roya Farhadi
- Department of Neonatology, Pediatrics
Infectious Diseases Research Center, Mazandaran University of Medical Sciences,
Sari, Iran,Roya Farhadi, Department of Neonatology,
Pediatrics Infectious Diseases Research Center, Mazandaran University of Medical
Sciences, Sari, Iran; Division of neonatology, Department of Pediatrics, Boo Ali
Sina Hospital, Pasdaran Boulevard, P.O.Box 48158-38477, Sari, Iran. Emails:
;
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Cacciatore M, Grasso EA, Tripodi R, Chiarelli F. Impact of glucose metabolism on the developing brain. Front Endocrinol (Lausanne) 2022; 13:1047545. [PMID: 36619556 PMCID: PMC9816389 DOI: 10.3389/fendo.2022.1047545] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022] Open
Abstract
Glucose is the most important substrate for proper brain functioning and development, with an increased glucose consumption in relation to the need of creating new brain structures and connections. Therefore, alterations in glucose homeostasis will inevitably be associated with changes in the development of the Nervous System. Several studies demonstrated how the alteration of glucose homeostasis - both hyper and hypoglycemia- may interfere with the development of brain structures and cognitivity, including deficits in intelligence quotient, anomalies in learning and memory, as well as differences in the executive functions. Importantly, differences in brain structure and functionality were found after a single episode of diabetic ketoacidosis suggesting the importance of glycemic control and stressing the need of screening programs for type 1 diabetes to protect children from this dramatic condition. The exciting progresses of the neuroimaging techniques such as diffusion tensor imaging, has helped to improve the understanding of the effects, outcomes and mechanisms underlying brain changes following dysglycemia, and will lead to more insights on the physio-pathological mechanisms and related neurological consequences about hyper and hypoglycemia.
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