Should diazoxide vs. placebo be used for treating neonatal hypoglycaemia?

Consider use of diazoxide if hypoglycaemia persists despite treatment with intravenous dextrose and is severe (<1.5 mmol/L) or unstable. [Conditional recommendation]

One randomised trial found that a low dose of diazoxide (3 mg/kg/day) for early management of severe or recurrent neonatal transitional hypoglycaemia may result in a large increase in the correction of hypoglycaemia after completing the loading dose (5 mg/kg). However, diazoxide did not reduce the time to resolution of hypoglycaemia.

One randomised trial conducted in India did not report on critical or important outcomes related to diazoxide use.

Evidence from five observational studies indicated that 71% of babies responded to diazoxide.

Diazoxide may be associated with serious side effects, including pulmonary hypertension, congestive heart failure, oedema, hypertrichosis (excessive hair growth), and necrotising enterocolitis. Most side effects resolve upon discontinuation of the drug, although hypertrichosis may persist for several weeks.

The cost of liquid diazoxide is moderate to high, at $620 per bottle, but costs are much lower (<$1) if prepared by a hospital pharmacy from tablets.
Oral administration of diazoxide may be preferable to parents compared to intravenous administration.

Diazoxide is not recommended as a first-line treatment due to significant potential adverse effects.

Discussions with whānau should include detailed information on dosing and possible side effects.

Input from endocrinology specialists is recommended for decision-making, and if hyperinsulinaemic hypoglycaemia is suspected.

Plasma insulin concentration should be measured before starting diazoxide.

Babies should be monitored carefully for possible side effects of diazoxide.

Studies are need on:

1. The long-term effect diazoxide.
2. The optimal dosage of diazoxide to minimise the risk of side effects.

Whānau need to be fully informed of the health benefits and potential adverse effects of diazoxide. Refer to health equity summary below.

Health equity for Māori

Health professionals must apply this guideline equitably to prevent harm and ensure accountability in implementing recommendations for Māori as part of a pro-equity approach. Pākehā benefit from health system privileges, while Māori face systemic racism, leading to reduced health benefits. Health equity can be improved if Māori receive effective interventions.

Ensure Māori whānau are fully informed about their healthcare options as a part of a mana motuhake (self-determination), including prevention, monitoring and treatment options, health benefits and potential risks. Detailed explanations of all interventions, their necessity, and results should also be provided to help achieve equitable health outcomes. Ensure whānau are provided with information in multiple formats (oral, written, online, video) that align with cultural values.

Whānau living in rural areas may face additional financial costs and barriers to accessing specialist services. Proactively support these whānau by informing and supporting them to access available financial assistance and resources to access specialist services.

Health equity for other groups

Health professionals must apply this guideline equitably to prevent harm. Health equity can be improved if all whānau receive effective interventions.
Many groups, including Pacific, Asian, migrant and rural communities, also face significant health inequities. These groups often encounter barriers such as language difficulties, lower health literacy, and challenges in understanding their healthcare options. It is important that all whānau are fully informed about their healthcare options, including prevention, monitoring and treatment options, health benefits and potential risks. Detailed explanations of all interventions, their necessity, and results should also be provided to help achieve equitable health outcomes. Culturally appropriate communication, use of interpreter services where required, along with the use of multiple formats (oral, written, online, video), can help improve engagement with health services.

Rural communities may also experience additional challenges, such as increased travel costs and limited access to specialist care. Providing proactive support, including information about and assistance to access financial and other resources to help access specialist services, is crucial to reducing these inequities and improving health outcomes. Specific additional issues are addressed under the recommendations and EtDs where relevant.