Priyadarshi Archana, Verge Charles F, Vandervliet Leah, Mackay Deborah J G, Bolisetty Srinivas
Royal Hospital for Women, Randwick, Sydney, Australia.
Sydney Children's Hospital, Randwick, Sydney, Australia.
BMC Pediatr. 2015 Dec 2;15:200. doi: 10.1186/s12887-015-0512-7.
Transient Neonatal Diabetes Mellitus is the commonest cause of diabetes presenting in the first week of life. Majority of infants recover by 3 months of age but are predisposed to developing type 2 diabetes later on in life. This condition is usually due to genetic aberrations at the 6q24 gene locus, and can be sporadic or inherited. This disorder has three phases: neonatal diabetes, apparent remission, relapse of diabetes.
Our case, a neonate presented with low birth weight and growth retardation along with the metabolic profile consistent with transient diabetes mellitus at birth. We report a novel clinical observation of recurrent asymptomatic hypoglycaemia detected on pre-feed blood glucose level monitoring in our case with transient neonatal diabetes mellitus at 6 weeks of age, 4 weeks after the remission of diabetes mellitus.
This case demonstrates that neonates in remission following transient diabetes mellitus can present with recurrent asymptomatic hypoglycaemia without any other obvious congenital malformations seen. This asymptomatic hypoglycaemia may persist for weeks and may be missed if pre-feed blood glucose level monitoring is not done in these infants. Also, these infants may require an aggressive enteral feeding regimen with high glucose delivery rate to maintain normoglycemia.
短暂性新生儿糖尿病是出生后第一周出现糖尿病的最常见原因。大多数婴儿在3个月大时康复，但日后患2型糖尿病的风险较高。这种情况通常是由于6q24基因位点的遗传异常，可为散发性或遗传性。这种疾病有三个阶段：新生儿糖尿病、明显缓解、糖尿病复发。
我们的病例是一名新生儿，出生时体重低、生长发育迟缓，且代谢情况与短暂性糖尿病相符。我们报告了一例新颖的临床观察结果，在我们这位患有短暂性新生儿糖尿病的病例中，糖尿病缓解4周后、6周龄时，在喂食前血糖水平监测中发现反复出现无症状低血糖。
该病例表明，短暂性糖尿病缓解后的新生儿可出现反复无症状低血糖，且无其他明显先天性畸形。这种无症状低血糖可能持续数周，如果不对这些婴儿进行喂食前血糖水平监测，可能会被漏诊。此外，这些婴儿可能需要积极的肠内喂养方案，以高葡萄糖输送率来维持血糖正常。
