Demand Breastfeeding in Infants using Diazoxide to manage Congenital Hyperinsulinism.

INTRODUCTION: Congenital Hyperinsulinism (CHI) is a rare condition which causes severe and profound hypoglycaemia. Breastfeeding is often stopped at diagnosis of CHI to reduce the likelihood of fluid overload during treatment with diazoxide, but without supportive evidence. Breastfeeding confers numerous advantages to all newborn babies and their mothers and may be safe and effective in babies with CHI. We aimed to evaluate whether demand breastfeeding in babies and infants with CHI receiving diazoxide therapy maintains safe glycaemic stability without risk of fluid overload. METHODS: A retrospective observational review was undertaken to test safety, efficacy and acceptability of breastfeeding alongside diazoxide treatment in 17 infants with biochemically confirmed CHI. Data was collected on feeding method, glycaemic outcomes, adverse effects, signs/symptoms of fluid overload and genetic aetiology of CHI. RESULTS: The cohort included 17 infants (13 males, 4 females). Two patients had genetic forms of CHI; due to ABCC8 and HNF4A variants, while the remaining infants were diagnosed with transient CHI. All infants were demand breastfed; four infants transitioned from restricted bottle feeding to successful demand breastfeeding during the treatment course. Duration of diazoxide therapy ranged from 5-13 weeks in patients with transient CHI. The two patients with genetic CHI required prolonged therapy, with treatment durations of 9-18 months at the time of the study. Glycaemic stability was maintained throughout the treatment period without any increase in hypoglycaemic episodes during transfer to breastfeeding or reductions in diazoxide. There was no clinical evidence of fluid overload across the patient cohort. No diazoxide related adverse effects were observed, and therapy did not interfere with breastfeeding progression. CONCLUSION: Study findings support the feasibility and safety of demand breastfeeding in infants receiving diazoxide for CHI. This supports metabolic stability and parental feeding goals. These findings suggest that breastfeeding should not be routinely discouraged in this population and can be safely pursued with appropriate monitoring.