Transient Diabetes of the Newborn

Abstract

The transient diabetes mellitus of the newborn is a diabetic syndrome most likely to occur in infants less than 6 weeks of age who at birth are underweight for their period of gestation. This group of infants is also more likely to develop transient hypoglycemia in the newborn period. Several infants have had both syndromes. The presenting symptoms are usually a failure to thrive and sudden severe dehydration associated with polyuria and fever in the absence of diarrhea and vomiting. There is a marked glucosuria and the hyperglycemia is striking, usually exceeding 600 mg./100 ml. Ketonuria, if present, is usually mild. The absence of ketonuria is an age-specific phenomenon and does not exclude the presence of ketonemia. The entity of transient diabetes of the newborn has many features in common with “hyperglycemia-hyperosmolar coma.” Insulin sensitivity is the rule and the infants have responded well to 1 to 3 units per kg. per day. Larger doses have resulted in severe hypoglycemia. Dehydration, when severe, should be treated with I.V. fluids. The use of sodium-deficient solutions have been associated with convulsions. The etiology of this syndrome remains unknown. Only the course differentiates transient from permanent diabetes mellitus. Most infants have developed normally, but 10 per cent are mentally retarded. However, the short period of follow-up in most recorded cases does not allow meaningful conclusions as to prognosis.