Endocrine Abstracts

Background: Dumping syndrome in infants who have undergone gastrostomy or Nissens fundoplication is a recognised phenomenon. The pathogenesis is possibly due to a bolus feed causing an incretin effect and leading to hyperinsulinaemic hypoglycaemia. Continuous glucose monitoring (CGM) systems have not been used in the past to study this phenomenon. We report CGM findings which are almost identical on three such post surgical infants.

Case series 1: a 36-week infant with VACTERL association underwent a gastrostomy and was noted to have hypoglycaemic episodes, once established on bolus enteral feeds. CGM revealed a typical sinusoidal pattern of hyperglycaemia and hypoglycaemia re;ated to feed timings (18% of the time <3 mmol/l over a 3-day period).

2: a term infant with complex congenital heart disease and 22q11 deletion underwent Nissen’s fundoplication and gastrostomy followed by post feed hypoglycaemia. CGM revealed hypoglycaemia (25% of the time) ~2 h after the feeds. Continous feeds resulted in the reduction of this pattern (9%) on repeat CGM.

3: an ex-26-week infant with tracheal oesophageal fistula and gastrostomy was noted to have swings in blood glucose levels after commencement of bolus feeds. CGM revealed significant hypoglycaemia (45%) while on bolus feeds.

Continuous feeds corrected the hypoglycaemias and all infants were gradually established on full bolus feeds. Bolus feeds administered using a pump was better than gravity dependant feeding.

Conclusion: Dumping syndrome should be actively sought for, in post-surgical neonates presenting with spontaneous hypoglycaemia. CGM findings seem to be unique and we recommend it as a useful tool to demonstrate the relationship between bolus feeds and hypoglycemia. Further simple manipulation of feed delivery will result in resolution of abnormalities.