Figure 2.

Algorithm for the treatment of hyperinsulinism. Assessing the response to diazoxide is a critical step in the management of HI. Patients who fail to respond to diazoxide will most likely have K_ATP channel defect and require referral to a specialized center with ¹⁸ F DOPA PET scan capability. A safety fast should be 8 to 18 h long depending on the age of the patient. Note that octreotide is not recommended as pre-operative treatment in neonates with HI due to high rate of treatment failure and risk of necrotizing enterocolitis. K_ATP = ATP-sensitive potassium channel, ¹⁸ F DOPA PET = 18-fluoro L-3,4-dihydroxyphenylalanine positron emission tomography.