Severe refractory hypoglycaemia in neonatal sepsis: clinical insights and management approach

A term, appropriate for gestational age (AGA) baby with no dysmorphism and no significant maternal risk factors, who cried immediately after birth, developed hypoglycaemic seizures at 10 hours of life. The baby had a positive sepsis screen and was treated with empirical antibiotics. Blood culture grew coagulase-negative <i>Staphylococcus</i> He developed hypoglycaemia requiring an increasing glucose infusion rate (GIR), going up to 23 mg/kg/min for 10 days. Critical sample analysis did not reveal hyperinsulinaemia. Urine for reducing substance was positive, but serum galactose was within normal limits. Tandem Mass Spectrometry and Gas Chromatography Mass Spectrometry reports were unremarkable, and whole exome sequencing was non-contributory. Intravenous hydrocortisone and oral diazoxide were added sequentially. With progressive resolution of sepsis, the infant's hypoglycaemia gradually improved, which allowed a stepwise reduction in glucose infusion requirements. By the 24th day of life, the GIR could be safely tapered off, and the baby was successfully transitioned to full breastfeeding. In addition, he developed portal venous thrombosis and was managed with low molecular weight heparin. On follow-up at 8 months, the baby was growing well on breastfeeding and neurodevelopmentally unremarkable.