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Severe transient neonatal hyperinsulinism associated with hyperlactataemia in non-asphyxiated infants

K Hussain1, P S Thornton, T Otonkoski

  • 1The London Centre for Paediatric Endocrinology and Metabolism, Great Ormond Street Hospital for Children and the Institute of Child Health, University College London, UK. K.Hussain@ich.ucl.ac.uk

Journal of Pediatric Endocrinology & Metabolism : JPEM
|April 2, 2004
PubMed

Insights

Transient hyperinsulinism (HI) and lactic acidosis in neonates is rare. This study describes five infants with this combination, suggesting potential links to metabolic pathway immaturity.

Area of Science:

  • Neonatology
  • Pediatric Endocrinology
  • Biochemistry

Background:

  • Transient hyperinsulinism (HI) is observed in infants of diabetic mothers, those with perinatal asphyxia, and intrauterine growth retardation.
  • Lactic acidosis in neonates often results from hypoxia, hypovolemia, anemia, or infection.
  • The co-occurrence of transient HI and lactic acidosis is uncommon, and its underlying mechanisms are not fully elucidated.

Purpose of the Study:

  • To describe the clinical and biochemical characteristics of infants presenting with transient hyperinsulinism and hyperlactatemia.
  • To investigate the association between transient hyperinsulinism and lactic acidosis in the absence of typical perinatal stress markers.

Main Methods:

  • Clinical case series presentation.
  • Biochemical analysis of plasma lactate levels in affected infants.

Main Results:

  • Five infants presented with transient hyperinsulinism and hyperlactatemia without indicators of perinatal stress.
  • This combined condition persisted for 3-4 weeks in most cases, with one infant showing resolution at 6 months.
  • The precise mechanism remains unclear, possibly involving pyruvate dehydrogenase complex immaturity or abnormal intramitochondrial metabolites.

Conclusions:

  • Transient hyperinsulinism associated with hyperlactatemia can occur in neonates without overt perinatal stress.
  • Further investigation into metabolic pathway development, such as the pyruvate dehydrogenase complex, is warranted.
  • Measuring plasma lactate levels in infants presenting with hyperinsulinism is recommended.

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