L Ognean1, O Boanta1, G Visa2, F Grosu3, C Şofariu4, M Gafencu5,6, C Matei7, S Iurian8. 1. "Lucian Blaga" University, Faculty of Medicine, Dept. of Neonatology, Sibiu, Romania. 2. Clinical Hospital of Pediatrics, Dept. of Neurology, Sibiu, Romania. 3. "Lucian Blaga" University, Faculty of Medicine, Dept. of Radiology, Sibiu, Romania. 4. Clinical Hospital of Pediatrics, Children's Neurological Diseases Research Center and Telemedicine (CEFORATEN), Sibiu, Romania. 5. "Victor Babes" University of Medicine and Pharmacy, Dept. of Pediatrics, Timisoara, Romania. 6. "Louis Turcanu" Emergency Children, Peritoneal Dialysis, Hospital, Timisoara, Romania. 7. "Lucian Blaga" University, Faculty of Medicine, Dept. of Neurosurgery, Sibiu, Romania. 8. Pediatric Hospital, Sibiu, Romania.
Abstract
CONTEXT: Diabetes mellitus is the most frequent chronic complication in pregnancy and continues to contribute to increased perinatal morbidity and mortality in newborns. Macrosomia, respiratory distress syndrome, metabolic and electrolytic disturbances, and increased rates of congenital structural defects are well-known neonatal complications associated with maternal diabetes, even if well-controlled. CASE REPORT: A macrosomic infant born from an insulin-dependent mother, with uncontrolled diabetes and lack of adequate prenatal care, prenatally diagnosed with hydrocephaly showed a complicated postnatal course. Initial respiratory distress syndrome and transient hypoglycemia, rapidly corrected under treatment, were followed by persistent hypocalcemia and hyperphosphatemia due to hypoparathyroidism and evolving hydrocephaly. Ventriculoperitoneal shunting was followed by resolution of hypocalcemia, but seizures associated with schizencephaly and recurrent respiratory tract infections, aggravated by spondylocostal dysplasia, concurred to infant's demise at the age of 5 months. CONCLUSIONS: The reported case is rare due to multiple aspects: persistent hypoparathyroidism, uncommon association of schizencephaly, and even rarely association with spondylocostal dysplasia, all these conditions requiring a multidisciplinary therapeutic approach. Also, the reported case is evocative for challenges associated with infants born from diabetic mothers.
CONTEXT: Diabetes mellitus is the most frequent chronic complication in pregnancy and continues to contribute to increased perinatal morbidity and mortality in newborns. Macrosomia, respiratory distress syndrome, metabolic and electrolytic disturbances, and increased rates of congenital structural defects are well-known neonatal complications associated with maternal diabetes, even if well-controlled. CASE REPORT: A macrosomic infant born from an insulin-dependent mother, with uncontrolled diabetes and lack of adequate prenatal care, prenatally diagnosed with hydrocephaly showed a complicated postnatal course. Initial respiratory distress syndrome and transient hypoglycemia, rapidly corrected under treatment, were followed by persistent hypocalcemia and hyperphosphatemia due to hypoparathyroidism and evolving hydrocephaly. Ventriculoperitoneal shunting was followed by resolution of hypocalcemia, but seizures associated with schizencephaly and recurrent respiratory tract infections, aggravated by spondylocostal dysplasia, concurred to infant's demise at the age of 5 months. CONCLUSIONS: The reported case is rare due to multiple aspects: persistent hypoparathyroidism, uncommon association of schizencephaly, and even rarely association with spondylocostal dysplasia, all these conditions requiring a multidisciplinary therapeutic approach. Also, the reported case is evocative for challenges associated with infants born from diabetic mothers.
Authors: Mary C M Macintosh; Kate M Fleming; Jaron A Bailey; Pat Doyle; Jo Modder; Dominique Acolet; Shona Golightly; Alison Miller Journal: BMJ Date: 2006-06-16