Unique brain anomalies in an infant of a diabetic mother.

An offspring of a class F diabetic primigravida with marginal control during the first 8 weeks of the gestation had a level II sonogram at 23 weeks. It showed polyhydramnios and "hydrocephaly." Macrosomia, right hydroureter, megacystis and premature birth corroborated the diagnostic impression of diabetic embryopathy. At age 3 years, the child functions within the moderate range of mental retardation. Angiography, choanogram, CT and MRI scans showed unique CNS abnormalities that appeared secondary to a hamartomatous growth within the left cerebral hemisphere. Such anomaly, most likely a part of the phenotype of the diabetic embryopathy, implies a growth disturbance secondary to dysregulated paracrine growth factors (somatomedins, nerve growth factor, panregulin and/or their receptors in this case). It also indicates a possibility of interaction between two dysregulated major growth mechanisms; the endocrine in the mother considered responsible for the overall phenotype of the diabetic embryopathy/fetopathy and the paracrine fine tuning mechanism in the embryo incriminated by the hamartomatous over/undergrowth.

Serum concentrations of growth hormone, insulin, free thyroxine, thyrotropin, and cortisol in very-low-birth-weight infants receiving total parenteral nutrition.

Serum concentrations of growth hormone, insulin, free thyroxine, thyrotropin, cortisol, and glucose were measured during four time periods (0 to 4, 5 to 11, 12 to 18, and greater than or equal to 19 days of life) in 16 mechanically ventilated very-low-birth-weight infants (mean [+/- SD] birth weight, 1017 +/- 196 g) receiving total parenteral nutrition and in 21 very-low-birth-weight infants not requiring mechanical ventilator support (mean [+/- SD] gestational age, 30 +/- 1.7 weeks; mean [+/- SD] birth weight, 1149 +/- 210 g) fed enterally. There were no significant differences in the serum concentrations of the hormones or in the glucose levels between the two groups at any time interval. Present data demonstrate no significant difference in the serum concentration of glucose, insulin, growth hormone, cortisol, free thyroxine, and thyrotropin between very-low-birth-weight infants fed enterally and those maintained on a regimen of total parenteral nutrition.