Rare neonatal diabetes insipidus and associated late risks: case report

Area of Science:

• Pediatric Neurology
• Neonatal Medicine
• Endocrinology

Background:

• Neonatal central diabetes insipidus (DI) frequently results from injury, often leading to associated disabilities.
• Prognosis in infants with DI depends on age, disability severity, and medical expertise.
• The rarity of neonatal DI limits clinical experience.

Observation:

• A term infant experienced right lower limb paresis, swallowing difficulties, and central DI following a neonatal hemorrhagic stroke linked to aortic coarctation.
• Progressive undernutrition due to impaired oral intake exacerbated developmental delays.
• Intranasal desmopressin absorption was hindered by common colds, leading to dehydration and further brain bleeding.
• An uncontrolled intravenous infusion resulted in central myelinolysis and quadriplegia, creating a complex clinical scenario.

Findings:

• Nutritional support via gastrostomy dramatically improved the child's neurodevelopment and overall progress.
• This case highlights the critical role of adequate nutrition in the sensitive neurodevelopment of infants.
• Intranasal desmopressin administration in young children carries potential risks, particularly concerning hydration and neurological complications.

Implications:

• Early and effective nutritional intervention is crucial for optimizing outcomes in infants with complex neurological conditions.
• Physicians should carefully consider alternative medication delivery methods and monitor hydration status closely during desmopressin treatment.
• This case underscores the need for comprehensive management strategies addressing both endocrine and nutritional deficits in affected neonates.