N/IICU Clinical Pathway for Evaluation/Treatment
of Persistent Hypoglycemia in the Newborn

Goals and Metrics
Patient Education
Provider Resources
Related Pathway
Interpretation of Lab Results
Consult Metabolism for
Suspected Metabolic Disease
Suspected Hyperinsulinism
  • HI Diagnostic criteria when glucose < 50 mg/dL
    • Detectable insulin > 2 mIU/mL
    • Low beta-hydroxybutyrate < 1.8 mmol/L
    • Low free fatty acids < 1.7 mmol/L
  • Treatment:
  • Treatment Goal:
    • Maintain euglycemia, glucose > 70 mg/dL for infants > 72 hrs of life
  • Fasting Test
    • On Diazoxide off IVF
    • Goal: Fasting time 6-12 hrs with plasma glucose maintained > 70
Fails Fast
Tolerates Fast
  • Diazoxide unresponsiveness suggests a KATP channel HI and potential surgical candidate
  • Send expedited genetic testing of ABCC8 and KCNJ11
  • Discontinue diazoxide
  • Maintain plasma glucose above 70 mg/dL with dextrose containing IVF
  • Consider central line placement to give higher dextrose concentration in IVF
  • Consider continuous glucagon infusion (1 mg/day) if fluid overload is a concern
  • Arrange transfer to CHOP for further care
    and potential 18F-DOPA PET
  • Continue diazoxide with glucose monitoring
  • Obtain ECHO, CBC with diff, and BMP 1 week after starting diazoxide or prior to discharge
  • Send comprehensive HI genetic testing
  • Discharge Planning with Endocrinology
Posted: September 2016
Revised: May 2023
Editors: Clinical Pathways Team