Bilateral basal ganglia infarctions in a neonate born during maternal diabetic ketoacidosis

Matthew B. Stenerson, Christopher A. Collura, Carl H. Rose, Aida N. Lteif, William A. Carey

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Diabetic ketoacidosis (DKA) during pregnancy carries significant risk of intrauterine fetal demise, but little is known about its postnatal sequelae in surviving neonates. We report here the case of an infant who was born to a mother with White's class C diabetes mellitus during an episode of DKA. Throughout pregnancy her glucose control was suboptimal, as evidenced by a predelivery glycosylated hemoglobin level of 8.1%. At 33 weeks' gestation, the mother presented with nausea and vomiting, a serum glucose concentration of 575 mg/dL, and other metabolic derangements consistent with DKA. Despite rehydration and insulin therapy, fetal distress necessitated cesarean delivery. At birth the infant required intubation, but her clinical status quickly improved and she was extubated within the first day of life. However, on day-oflife 4 she exhibited seizure-like activity, and subsequent brain MRI revealed bilateral basal ganglia infarctions. Previous research has revealed that the keto acid β-hydroxybutyrate (β-OHB) can cross the placenta into the fetal circulation and thereafter accumulate in the fetal brain, which leads to severe metabolic derangements. Furthermore, β-OHB accumulates rapidly in the basal ganglia of older children during episodes of DKA, wherein its presence is associated with neuronal injury. We suspect that transplacental transfer of maternal β-OHB led to an acquired ketoacidosis in the fetus and that accumulation of β-OHB contributed to neuronal injury and subsequent infarction of the basal ganglia. Further research is necessary to better characterize neonatal complications of maternal DKA, as well as the possible inclusion of β-OHB levels in the goal-directed treatment of this disease.

Original languageEnglish (US)
JournalPediatrics
Volume128
Issue number3
DOIs
StatePublished - Sep 2011

Fingerprint

Diabetic Ketoacidosis
Basal Ganglia
Infarction
Mothers
Newborn Infant
Pregnancy
Hydroxybutyrates
Keto Acids
Glucose
Fetal Distress
Ketosis
Fetal Death
Fluid Therapy
Wounds and Injuries
Glycosylated Hemoglobin A
Brain
Research
Intubation
Nausea
Placenta

Keywords

  • Basal ganglia
  • Diabetes mellitus
  • Diabetic ketoacidosis
  • Neonatal
  • Pregnancy

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Stenerson, M. B., Collura, C. A., Rose, C. H., Lteif, A. N., & Carey, W. A. (2011). Bilateral basal ganglia infarctions in a neonate born during maternal diabetic ketoacidosis. Pediatrics, 128(3). https://doi.org/10.1542/peds.2010-3597

Bilateral basal ganglia infarctions in a neonate born during maternal diabetic ketoacidosis. / Stenerson, Matthew B.; Collura, Christopher A.; Rose, Carl H.; Lteif, Aida N.; Carey, William A.

In: Pediatrics, Vol. 128, No. 3, 09.2011.

Research output: Contribution to journalArticle

Stenerson, Matthew B. ; Collura, Christopher A. ; Rose, Carl H. ; Lteif, Aida N. ; Carey, William A. / Bilateral basal ganglia infarctions in a neonate born during maternal diabetic ketoacidosis. In: Pediatrics. 2011 ; Vol. 128, No. 3.
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