Octreotide
1
Reactions 1316 - 28 Aug 2010 S Octreotide Acute necrotising enterocolitis in neonates: 4 case reports Four full-term neonates developed acute necrotising enterocolitis while receiving octreotide for congenital hyperinsulinism. Patient 1, a male newborn, started receiving diazoxide within his first week of life. However, his glucose levels were not controlled and on day of life 16 (DOL 16) SC octreotide 10 µg/kg/day was started, titrated up to 20 µg/kg/day. Nifedipine was started on DOL 29, and on DOL 32 he developed symptoms of severe enterocolitis. An exploratory laparotomy revealed necrosis of the entire GI tract, from the duodenum to the rectum, and he died a few hours later. Patient 2, a female newborn, started receiving diazoxide on DOL 12 and SC octreotide 10 µg/kg/day was started on DOL 19. Two days later, she developed significant abdominal distension and bilious emesis; antibacterials were initiated and she quickly improved. On DOL 22 diazoxide was discontinued and octreotide titrated up to 20 µg/kg/day. On DOL 28 she underwent a 98% pancreatectomy, during which dense adhesions around the right colon and a contained perforation of the appendix tip were noted as being consistent with a previous episode of severe inflammation. Her post-operative course was uneventful and she was discharged on DOL 41. Patient 3, a male newborn, started receiving diazoxide on DOL 8. This was discontinued a few days later due to a lack of response. On DOL 20 octreotide 15 µg/kg/day was started and titrated to 20 µg/kg/day. Three days after octreotide was started he developed bloody stools, abdominal distension, and diffuse pneumatosis intestinalis and portal air on abdominal plain films. Octreotide was discontinued, antibacterials started, and a laparotomy showed extensive necrosis of the small intestine and colon. He subsequently underwent multiple intestinal segment resection surgeries and recovered completely. His hyperinsulinism was managed medically rather than surgically. Patient 4, a female newborn, started receiving octreotide within the first 2 weeks of life and on DOL 31 was receiving SC octreotide 15 µg/kg/day. Three days later she developed bloody stools and octreotide was stopped. On DOL 38 she underwent 98% pancreatectomy, during which her right colon was noted to be oedematous and discoloured but viable. Her post-operative course was uneventful and she was discharged home on DOL 57. Author comment: "In our opinion, the benefits of OTT [octreotide] in the management of congenital HI [hyperinsulinism] are clear and outweigh all the secondary effects known so far." Laje P, et al. Necrotizing enterocolitis in neonates receiving octreotide for the management of congenital hyperinsulinism. Pediatric Diabetes 11: 142-147, Mar 2010. Available from: URL: http://dx.doi.org/10.1111/j.1399-5448.2009.00547.x - USA 803035782 1 Reactions 28 Aug 2010 No. 1316 0114-9954/10/1316-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
Transcript of Octreotide
Reactions 1316 - 28 Aug 2010
SOctreotide
Acute necrotising enterocolitis in neonates:4 case reports
Four full-term neonates developed acute necrotisingenterocolitis while receiving octreotide for congenitalhyperinsulinism.
Patient 1, a male newborn, started receiving diazoxidewithin his first week of life. However, his glucose levelswere not controlled and on day of life 16 (DOL 16) SCoctreotide 10 µg/kg/day was started, titrated up to20 µg/kg/day. Nifedipine was started on DOL 29, and onDOL 32 he developed symptoms of severe enterocolitis. Anexploratory laparotomy revealed necrosis of the entire GItract, from the duodenum to the rectum, and he died a fewhours later.
Patient 2, a female newborn, started receiving diazoxideon DOL 12 and SC octreotide 10 µg/kg/day was started onDOL 19. Two days later, she developed significantabdominal distension and bilious emesis; antibacterialswere initiated and she quickly improved. On DOL 22diazoxide was discontinued and octreotide titrated up to20 µg/kg/day. On DOL 28 she underwent a 98%pancreatectomy, during which dense adhesions around theright colon and a contained perforation of the appendix tipwere noted as being consistent with a previous episode ofsevere inflammation. Her post-operative course wasuneventful and she was discharged on DOL 41.
Patient 3, a male newborn, started receiving diazoxide onDOL 8. This was discontinued a few days later due to a lackof response. On DOL 20 octreotide 15 µg/kg/day wasstarted and titrated to 20 µg/kg/day. Three days afteroctreotide was started he developed bloody stools,abdominal distension, and diffuse pneumatosis intestinalisand portal air on abdominal plain films. Octreotide wasdiscontinued, antibacterials started, and a laparotomyshowed extensive necrosis of the small intestine and colon.He subsequently underwent multiple intestinal segmentresection surgeries and recovered completely. Hishyperinsulinism was managed medically rather thansurgically.
Patient 4, a female newborn, started receiving octreotidewithin the first 2 weeks of life and on DOL 31 was receivingSC octreotide 15 µg/kg/day. Three days later she developedbloody stools and octreotide was stopped. On DOL 38 sheunderwent 98% pancreatectomy, during which her rightcolon was noted to be oedematous and discoloured butviable. Her post-operative course was uneventful and shewas discharged home on DOL 57.
Author comment: "In our opinion, the benefits of OTT[octreotide] in the management of congenital HI[hyperinsulinism] are clear and outweigh all the secondaryeffects known so far."Laje P, et al. Necrotizing enterocolitis in neonates receiving octreotide for themanagement of congenital hyperinsulinism. Pediatric Diabetes 11: 142-147, Mar2010. Available from: URL: http://dx.doi.org/10.1111/j.1399-5448.2009.00547.x -USA 803035782
1
Reactions 28 Aug 2010 No. 13160114-9954/10/1316-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
