Minimal dose of octreotide causing necrotizing enterocolitis in a neonate with congenital hyperinsulinism – A rare case report

Hyperinsulinism is the most common cause of persistent refractory hypoglycemia in the newborn. Attaining glycemic goals with parenteral fluids alone, often, is not possible and drugs such as diazoxide and octreotide (OTT) are required to be instituted. OTT has been reported to cause vasoconstriction of splanchnic vasculature, though, clinical manifestations in the form of gut ischemia and necrotizing enterocolitis (NEC) have only been rarely described at higher doses. We report a case of a preterm, for large gestational age baby who developed hypoglycemia since day 1 of life which was persistent and refractory. On critical sample evaluation, a diagnosis of congenital hyperinsulinism was made which was further confirmed by genetic analysis. In view of non-response to diazoxide, OTT was initiated at the recommended starting dose after which the child developed NEC. The occurrence of NEC with OTT use at minimal dose suggests a possible idiosyncratic, rather than dose dependent, effect of OTT on the gut and thus, warranting caution by the clinicians even when using this drug at the recommended starting dose.