ObjectivesDiazoxide (DZX) is the drug of choice for treating hyperinsulinaemic hypoglycaemia (HH), and it has potentially serious adverse effects. We studied the safety and efficacy of low-dose DZX in small-for-gestational-age (SGA) infants with HH.DesignAn observational cohort study from 1 September 2014 to 31 September 2020.SettingA tertiary Women’s and Children’s Hospital in Singapore.PatientsAll SGA infants with HH.InterventionDiazoxide, at 3–5 mg/kg/day.Main outcome measuresShort-term outcomes; adverse drug events and fasting studies to determine ‘safe to go home’ and ‘resolution’ of HH.ResultsAmong 71 836 live births, 11 493 (16%) were SGA. Fifty-six (0.5%) SGA infants with HH were identified, of which 27 (47%) with a mean gestational age of 36.4±2 weeks and birth weight of 1942±356 g required DZX treatment. Diazoxide was initiated at 3 mg/kg/day at a median age of 10 days. The mean effective dose was 4.6±2.2 mg/kg/day, with 24/27 (89%) receiving 3–5 mg/kg/day. Generalised hypertrichosis occurred in 2 (7.4%) and fluid retention in 1 (3.7%) infant. A fasting study was performed before home while on DZX in 26/27 (96%) cases. Diazoxide was discontinued at a median age of 63 days (9–198 days), and resolution of HH was confirmed in 26/27 (96%) infants on passing a fasting study.ConclusionOur study demonstrates that low-dose DZX effectively treats SGA infants with HH as measured by fasting studies. Although the safety profile was excellent, minimal adverse events were still observed with DZX, even at low doses.

We thank the authors for this informative article and would like to contribute by sharing our experience from the KK Human Milk Bank (KKHMB), the only donor human milk bank in Singapore, which supplies pasteurized donor human milk (PDHM) to all public and private maternity facilities, as well as to patients in the community. With the evolving Covid-19 pandemic, Singapore has entered into a "circuit breaker" since April 7, 2020 as a measure to contain the virus' spread. Only essential services such as hospitals, clinics, supermarkets, delivery services, food suppliers, and energy manufacturers, are allowed to operate from their premises with safe distancing and hygiene measures such as use of masks at all times and temperature screening of staff and visitors. The rest are only allowed to work from home using telecommuting services. Hospitals have also had to scale down non-emergency services such as elective surgeries and appointments. Considering the benefits of breastmilk and its strong protective effects against infectious diseases, the World Health Organization (WHO) recommends that infants born to mothers with suspected or confirmed Covid-19 infection should be breastfed while applying all the necessary infection control measures (WHO, 2020). If the mother is too ill to breastfeed or express breastmilk, donor human milk should be used (WHO, 2020). Thus, milk banks provide a valuable and essential service by supplying PDHM, which can be life saving for vulnerable preterm infants. Hence, in addition to the stringent guidelines that are already in place for donor and milk screening, KKHMB has implemented the following in accordance with the recommendations from the Human Milk Banking Association of North America (2020) and the European Milk Banking Association (2020) with regards to Covid-19:

Objective To evaluate prevalence and risk factors of moderate-severe Bronchopulmonary dysplasia (BPD)/Death in extremely low gestation age neonates (ELGANs). Study design Study of 266 ELGANs born at gestational age (GA) ≤ 28 weeks (w). Primary Outcome measure-composite outcome of moderate-severe BPD/Death using the National Institute of Child Health and Human Development NICHD's (2001) BPD definition.Result Cohort's mean GA and birth-weight (BW) were 25.3 ± 1.4w and 724 ± 14 g respectively with an overall mortality of 19% and moderate-severe BPD of 67%. Prevalence of moderate-severe BPD/death decreased significantly with increasing GA (86-93%) at 23-24 w; to <60% at 27-28w (OR 0.63; 95% CI; 0.52-0.77). On univariate analysis, other risk factors included BW(OR 1.005; 95% CI; 1.003-1.007), Sepsis (OR 2.9; 95% CI, 1.3-6.4), PDA needing treatment (OR 2.2; 95% CI, 1.3-3.9); air leaks (OR 2.7; 95% CI; 1.02-7.3) FiO 2 requirement >25%(OR 1.06; 95% CI; 1.01-1.11); and mechanical ventilation(MV) on Day7 (OR5.5; 95% CI; 2.8-10.8). Only need for Day7 MV was independently predictive of composite outcome (OR1.97; 95% CI; 1.3-3.1). Conclusion Risk factor identification will enable initiatives to implement lung protective strategies and develop prospective models for BPD prediction and prognostication.