Clinical and laboratory observationNeonatal hypoglycemia and occipital cerebral injury
Section snippets
Subjects
Between January and December 2004, infants born at full term and admitted to the neonatal intensive care unit (NICU) with a primary diagnosis of hypoglycemia were identified from our database. Our NICU is a referral center with no inborn infants. Infants with perinatal asphyxia or a structural cerebral abnormality were excluded. The antenatal, intrapartum, and postnatal clinical records were reviewed. Biochemical investigations, including endocrine profile, urine metabolic screen, and
Results
Six infants were identified. One infant with a long chain fatty acid oxidation defect was excluded because of cerebral dysgenesis. A second infant with perinatal asphyxia was also excluded.
Cases 1 and 2 had hypoglycemic seizures. Case 3 was identified when screened because of maternal gestational diabetes mellitus. A diagnosis of transient hyperinsulinism was established in cases 1, 2, and 3, and they required intravenous dextrose therapy for 5, 11, and 9 days, respectively. Case 2 was also
Discussion
We describe 4 infants with hypoglycemic encephalopathy in the neonatal period, which has resulted in brain injury predominantly affecting the occipital lobe. The pattern of occipital regional vulnerability supports that described in previous reports. Although this series is small, each infant had prolonged and repeated hypoglycemia. Three of the 4 infants had a definitive diagnosis of transient hyperinsulinism, and each infant underwent serial MRI. In our serial scans, areas of injury evident
References (18)
- et al.
Hypoglycemic brain injury
Semin Neonatol
(2001) - et al.
Glucose metabolism in the developing brain
Semin Perinatol
(2000) - et al.
Symptomatic occipital lobe epilepsy following neonatal hypoglycemia
Pediatr Neurol
(2004) - et al.
Effects of neonatal hypoglycaemia on the nervous systema pathological study
J Neurol Neurosurg Psychiatry
(1967) Developmental pathology of the neonate
(1977)- et al.
Neonatal hypoglycemiaCT and MR findings
AJNR Am J Neuroradiol
(1994) - et al.
MR findings of neonatal hypoglycemia
AJNR Am J Neuroradiol
(1997) - et al.
Imaging patterns in neonatal hypoglycemia
AJNR Am J Neuroradiol
(1998) - et al.
Brain imaging in neonatal hypoglycemia
Arch Dis Child Fetal Neonatal Ed
(1998)