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Observed hepatic dysfunction following diazoxide administration in a neonate with liver impairment: A case report

Zulkeflee HA, Zulkefli NA, Mohammad Khuzaini A

J Neonatal Perinatal Med, 2025 Mar 18.
PMID: 40103299 DOI: 10.1177/19345798251327371

Diazoxide is commonly used to treat neonatal hypoglycaemia when first-line treatment fails by inhibiting insulin secretion. We present a case of a full-term female infant with refractory hypoglycaemia who developed elevated liver enzymes and worsening jaundice following diazoxide administration. After discontinuation of diazoxide, her liver enzyme levels rapidly improved. Although liver impairment has not been commonly reported as a side effect of diazoxide, previous reports, such as one by Tas et al. in 2015, have documented similar findings in patients with hypoalbuminemia, where altered drug metabolism may play a role. Diazoxide undergoes metabolism in the liver, raising the possibility that preexisting liver impairment could affect its clearance and potentially exacerbate hepatic dysfunction. These observations suggest that careful consideration is required when using diazoxide in neonates with compromised liver function. Further studies are needed to explore the mechanisms that may contribute to this association and to establish guidelines for its use in this vulnerable population. This case challenges the conventional understanding of diazoxide as a safe intervention for neonatal hypoglycaemia. Additional research is required to elucidate the mechanisms leading to hepatotoxicity and to establish clear guidelines for the use of diazoxide in this vulnerable population.
Tumour lysis syndrome in a neonate with transient abnormal myelopoiesis

Mohammad Khuzaini A, Mohd Baharudin JA, Md Fauzi A, Zulkeflee HA, Abdul Halim H, Mazli SK, et al.

J Neonatal Perinatal Med, 2024;17(2):269-273.
PMID: 38728206 DOI: 10.3233/NPM-230146

BACKGROUND: Tumor lysis syndrome (TLS) is an oncological emergency associated with hematological malignancies or highly proliferative solid tumors, commonly after chemotherapy. It is rarely associated with transient abnormal myelopoiesis.
OBSERVATION: We report a rare case of a neonate with transient abnormal myelopoiesis and tumor lysis syndrome, complicated with concomitant heart failure due to an underlying atrioventricular septal defect. Hyperhydration was contraindicated due to heart failure. The patient was managed conservatively with full recovery.
CONCLUSION: Tumor lysis syndrome should be suspected in neonates with transient abnormal myelopoiesis with electrolyte abnormalities. Treatment options should be considered carefully for their risks and benefits.

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