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Infant Death Following Home Birth: A Case Report of Fatal Neonatal Hypoglycemia.

Authors
  • Schuppener, Leah M1
  • Corliss, Robert F1
  • 1 Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison Hospital and Clinics, 600 Highland Ave, Madison, WI, 53792.
Type
Published Article
Journal
Journal of forensic sciences
Publication Date
Dec 04, 2019
Identifiers
DOI: 10.1111/1556-4029.14247
PMID: 31800970
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Infants born to diabetic mothers are at increased risk for symptomatic hypoglycemia and death after birth. A 36-year-old G4P3 mother with a history of gestational diabetes and newly diagnosed type II insulin-dependent diabetes gave birth at home, in the care of a midwife, to a macrosomic infant girl (10 lbs.). Several hours after birth, the infant became lethargic and was found to be hypoglycemic (blood sugar: 28 mg/dL). Glucose and sugar water were administered by the midwife; however, the infant continued to decompensate. Emergency medical services were called, and the infant was transported to the hospital where, despite resuscitative efforts, she died. An autopsy and review of the literature was performed. At autopsy, characteristic features of maternal-fetal glucose dysregulation were identified, including fetal macrosomia, cardiomegaly, hepatomegaly, and severe pancreatic islet cell hypertrophy/hyperplasia. Developmental abnormalities and other potential causes of death were not identified. Although deaths due to hypoglycemia cannot be reliably diagnosed postmortem using vitreous glucose levels, a clinical history of maternal glucose dysregulation in combination with certain gross and histologic findings should prompt a pathologist to consider maternal-fetal glucose dysregulation as a diagnosis of exclusion and cause of death. © 2019 American Academy of Forensic Sciences.

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