Mizumoto Hiroshi, Iki Yoichi, Yamashita Sumie, Kawai Masahiko, Katayama Toshiro, Hata Daisuke
Department of Pediatrics, Medical Research Institute, Kitano Hospital Tazuke Kofukai, Osaka, Japan.
Neonatology. 2015;108(2):88-92. doi: 10.1159/000381701. Epub 2015 Jun 2.
Small for gestational age and birth asphyxia are associated with neonatal transient hyperinsulinism (THI). Some newborns with THI showed marked erythroblastosis on admission to our neonatal intensive care unit.
This study was designed to test our hypothesis that fetal erythroblastosis may be a risk factor for developing THI.
The records of all babies admitted to our neonatal intensive care unit within 24 h of birth between January 2010 and May 2014, and who were born after 34 weeks of gestation, were retrospectively reviewed. Hyperinsulinism was diagnosed as hypoglycemia concomitant with high serum insulin in babies requiring >6 mg/kg/min intravenous glucose and THI as hyperinsulinism without maternal diabetes or genetic disorders. The following three possible risk factors for THI were evaluated: (1) birth weight z-score, (2) 1-min Apgar score and (3) absolute nucleated red blood cell (aNRBC) count on admission.
Of 705 infants, 8 were diagnosed with THI. Multivariate logistic regression analysis revealed that the aNRBC count was the most significant risk factor for THI. The median aNRBC count was 181/µl (interquartile range 0-538/µl), and 8 of 71 infants (11.3%) having an aNRBC count >1,413/µl (90th percentile in this study) had THI. The aNRBC counts in the 8 cases with THI were significantly higher than those in the 5 cases with hyperinsulinism caused by maternal diabetes or genetic disorders.
This study showed that the aNRBC count was strongly associated with subsequent THI. Fetal erythroblastosis, characterized by chronic fetal hypoxia, may be an indicator of perinatal stress sufficient to cause THI.
小于胎龄儿和出生窒息与新生儿短暂性高胰岛素血症（THI）有关。一些患有THI的新生儿在入住我们的新生儿重症监护病房时表现出明显的红细胞增多症。
本研究旨在验证我们的假设，即胎儿红细胞增多症可能是发生THI的危险因素。
回顾性分析2010年1月至2014年5月期间在出生后24小时内入住我们新生儿重症监护病房、孕周大于34周的所有婴儿的记录。高胰岛素血症被诊断为在需要静脉输注葡萄糖速度>6mg/kg/min的婴儿中伴有高血清胰岛素的低血糖症，而THI被诊断为无母体糖尿病或遗传疾病的高胰岛素血症。评估了以下THI的三个可能危险因素：（1）出生体重z评分，（2）1分钟阿氏评分，（3）入院时绝对有核红细胞（aNRBC）计数。
705名婴儿中，8名被诊断为THI。多因素逻辑回归分析显示，aNRBC计数是THI最显著的危险因素。aNRBC计数中位数为181/μl（四分位间距0 - 538/μl），71名aNRBC计数>1413/μl（本研究中第90百分位数）的婴儿中有8名（11.3%）患有THI。8例THI患儿的aNRBC计数显著高于5例由母体糖尿病或遗传疾病引起的高胰岛素血症患儿。
本研究表明，aNRBC计数与随后发生的THI密切相关。以慢性胎儿缺氧为特征的胎儿红细胞增多症可能是足以导致THI的围产期应激的一个指标。
