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2014 ; 43
(3
): e56-60
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Hyperinsulinism in a neonate
#MMPMID24605860
Blanco M
; Khan O
; Stanley K
; Hageman JR
; Greeley SA
Pediatr Ann
2014[Mar]; 43
(3
): e56-60
PMID24605860
show ga
A male patient was born small for gestational age (SGA) at 33 weeks with a birth
weight of 1,663 grams (< 10th percentile) and length 43 cm (10th percentile) to a
38-year-old G5P4 mother by cesarean section due to non-reassuring fetal heart
tones. Prior to delivery, his mother experienced decreased fetal movement and
decelerations. At birth, he was initially well-appearing and vigorous, with Apgar
scores of 7 and 8 at 1 and 5 minutes, respectively. The physical examination was
unremarkable--no skin findings, no facial anomalies, good tone, and the anterior
fontanelle was soft and flat. The placenta, although noted to be healthy in
appearance on prenatal ultrasounds, was atrophic and calcified by gross
examination. The patient developed respiratory distress 1 hour after birth and
was found to have a blood glucose level of 24 mg/dL. Following an intravenous
(IV) bolus of 10% dextrose in water (D10W) of 2 mL/kg, his glucose was 20 mg/dL.
He was started on IV fluids with a glucose infusion rate (GIR) of 7.3
mg/kg/minute, with a subsequent rise in blood glucose to 46 mg/dL. Due to
prematurity, respiratory distress, and persistent hypoglycemia, a diagnostic
evaluation was initiated for possible sepsis, including a complete blood count
with differential and platelet count and blood cultures. The patient was started
empirically on IV ampicillin and gentamicin. The patient was subsequently found
to have thrombocytopenia, hypomagnesemia, and hyponatremia on laboratory
evaluation and was transferred to our neonatal intensive care unit (NICU) for
further care.