A neonate born to a diabetic mother has a blood glucose of 28 mg/dL at 2 hours of age. He is jittery with a high-pitched cry. Which of the following best explains the mechanism of neonatal hypoglycemia in this infant?
- A Decreased glycogen stores due to prematurity
- B Deficiency of glucagon secretion
- C Persistent hyperinsulinism from fetal beta-cell hyperplasia ✓
- D Adrenal insufficiency causing cortisol deficiency
Correct answer: C. Persistent hyperinsulinism from fetal beta-cell hyperplasia
Explanation
In infants of diabetic mothers (IDM), chronic fetal hyperglycemia stimulates fetal pancreatic beta-cell hyperplasia, leading to elevated fetal insulin levels. After birth, when the glucose supply from the mother abruptly ceases, the persisting hyperinsulinism rapidly depletes neonatal blood glucose, causing symptomatic hypoglycemia. IDMs are also macrosomic due to the anabolic effects of fetal insulin. Early and frequent feeding or IV dextrose is required for management.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.