Infant Death Following Home Birth: A Case Report of Fatal Neonatal Hypoglycemia. Issue 3 (4th December 2019)

• Record Type: Journal Article
• Authors: Schuppener, Leah M.; Corliss, Robert F.
• Is Part Of: Journal of forensic sciences. Volume 65:Issue 3(2020)
• Page Start: 995
• Page End: 998
• Publication Date: 2019-12-04
• Subjects: neonatal hypoglycemia -- forensic pathology -- autopsy -- gestational diabetes -- pancreatic islet cell hyperplasia/hypertrophy (ICHH) -- homebirth -- infants of diabetic mothers; Medical jurisprudence -- Periodicals; Forensic sciences -- Periodicals; Forensic Medicine -- Periodicals; Gerechtelijke geneeskunde; Gerechtelijke chemie; Gerechtelijke psychiatrie; 363.2505
• DOI: 10.1111/1556-4029.14247
• Languages: English
• ISSNs: 0022-1198

Abstract

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.