Neonatal hyperglycaemia: case report with plasma insulin studies.

It is now established that the dysmature infant, of low birthweight for the period of gestation, may develop a diabetic state in the neonatal period (Arey, 1953; Engleson and Zetterqvist, 1957; Hutchison, Keay, and Kerr, 1962). This condition, which is temporary and has a good prognosis, has to be distinguished from other causes of hyperglycaemia. Permanent diabetes mellitus occurs rarely in the neonatal period (Guest, 1949; Gans, 1953; HofmanBang, 1954). Ketosis and acetonuria occur in these cases whereas this is not a feature in the temporary type. Infection and cerebral damage may also cause hyperglycaemia and in some of the reported cases of neonatal diabetes this may have been a factor (Strandqvist, 1932; Lewis and Eisenberg, 1935; Limper and Miller, 1935; Devine, 1938). Hyperglycaemia associated with dysmaturity is uncommon, though probably not so rare as reported cases would suggest. More commonly, hypoglycaemia may develop during the first few days after birth (Neligan, Robson, and Watson, 1963; Neligan, 1965; Shelley and Neligan, 1966; Campbell, Ferguson, Hutchison, and Kerr, 1967), and Chance and Bower (1966) reported a case of symptomatic hypoglycaemia where temporary hyperglycaemia developed later. The nature of the abnormality in these conditions is uncertain and insulin studies have been limited. A case is described here in which insulin studies were made on the first day of life because of dysmaturity, when blood glucose was low (22 mg./100 ml.), and on the 6th day of life, when hyperglycaemia developed.