The Syndroma Hypoglycemia‐Hydrops‐Erythroblastemia in New‐born

Summary. The pre‐conditions for the appearence of hypoglycemia should be found in the new‐born. There is, too, a certain physiological hypoglycemia during the first week of life, but it is seldom accompanied by clinical symptoms. An exception to this is provided by the infants of diabetic mothers, in whom special, hitherto unexplained, disturbances are present The author has observed 4 cases of hypoglycemia with clinical symptoms in infants of healthy mothers. Disturbances in blood sugar regulation were revealed, apart from the hypoglycemia, by means of glucose loading curves with abnormal courses. The clinical symptoms consisted of convulsions in 3 cases, attacks of cyanosis in all 4 cases, obvious difficulties in feeding in 3 cases The occurrence of these symptoms also in cases of intracranial hemorrhage is pointed out, and in that connection — when hemorrhagia intracranialis is suspected on account of these symptoms but not verified — the importance is indicated of determining the blood sugar in order to avoid possible erroneous diagnosis In addition to the hypoglycemia with its clinical symptoms, some further symptoms of interest in these infants are pointed out: three of the infants were more or less hydropic , in one of the cases hydramnion was present at partus and in three of the cases a definitely pathological erythroblastemia was proved The author advances the suggestion that the whole of this morbid picture might be due to debility, a deficient biological maturity, in which, above all, a liver insufficiency is assumed to be the most important factor. The central position of the liver in the regulation of the blood sugar, its importance for the fluid metabolism and for the extra‐medullary formation of blood, are pointed out as reasons why a biologically immature liver might give ride to this morbid picture However, other aspects of the etiology of the morbid picture in these cases are brought out by a comparison with the condition in the infants of diabetic mothers. According to the casuistics, the latter may exhibit exactly the same symptoms: hypoglycemia, attacks of cyanosis, convulsions, difficulties in feeding, hydramnion, hydrops, erythroblastemia. On the other hand, in cases of typical familial erythroblastosis, hydrops universalis congenita and ieterus gravis neonatorum, extreme hyperplasia of the insular elements of pancreas has been shown, as well as pathological stores of glycogen in different organs — a morphological expression of hyperinsulinism In view of the similarity between the symptom pictures in the cases described by the present author and those of the children of diabetic mothers, where a hormonal disturbance is considered to be present, the author's cases are also apprehended as being hormonally conditioned The blood sugar has been determined by the Hagedorn method and, in most cases, double determinations were made.