Mother With Diabetes Mellitus and Infant With Hypertrophic Obstructive Cardiomyopathy
Milrinone Precluded Need for Extracorporeal Membrane Oxygenation
This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
A female infant was born at 38 weeks to a mother with gestational diabetes mellitus (Hemoglobin A1c 6.7%) via an elective C-section for fetal macrosomia (birth weight 5560 g; >99.9%). The prenatal ultrasound was only significant for a large for gestational age fetus without any structural cardiac anomalies. Within the first 2 hours, the infant developed hypoglycemia and required respiratory support (nasal cannula) for respiratory distress and hypoxemia. Neonatal hyperinsulinemia (297 uIU/mL [1.9–23 uIU/mL]) confirmed maternal gestational diabetes mellitus as the cause of the hypoglycemia (growth hormone and cortisol levels were normal for age). The infant was electively intubated for worsening respiratory status. A transthoracic echocardiogram showed severe biventricular hypertrophy, especially the interventricular septum (1.2 cm at the end of systole; z score=4.55) causing left ventricular outflow tract (LVOT) obstruction with a gradient of 22 mm Hg (Figure 1; Movies I and II in the Data Supplement). The left ventricular cavity size was remarkably diminished. A color Doppler showed a …