A small-for-gestation term infant born to a mother with severe preeclampsia becomes lethargic and jittery at 3 hours of life. Capillary glucose is 28 mg/dL. The principal reason this infant is prone to early hypoglycemia is:

• A Excessive glycogen stored in the liver from chronic placental insufficiency
• B Renal glycosuria wasting filtered glucose
• C Delayed maturation of pancreatic alpha cells preventing glucagon release
• D Depleted glycogen and fat stores combined with high brain glucose consumption per kilogram ✓

Explanation

Chronic placental insufficiency deprives the fetus of glucose, so glycogen and adipose reserves laid down in the third trimester are depleted. After birth, the neonatal brain consumes glucose at up to twice the adult rate per kilogram, exhausting the small reserve within hours. Alpha cell function is present and glucagon rises normally, and neonates do not waste significant filtered glucose, so options C and B do not explain the early fall.

Reference: Nelson Textbook of Pediatrics, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.