0
November 1990, Vol 144, No. 11 >
Article | November 1990

Disproportionate Septal Hypertrophy Associated With Erythroblastosis Fetalis FREE

Brian S. Carter, MC, USA; Jane E. DiGiacomo, MD; Scott M. Balderston, MC, USN; James W. Wiggins, MD; Gerald B. Merenstein, MD
[+] Author Affiliations

Accepted for publication March 26, 1990.

The views of the authors do not purport to reflect the positions of the Departments of the US Army, US Navy, or Defense.

Reprint requests to Division of Perinatal Medicine, Box B-199, University of Colorado Health Sciences Center, 4200 E Ninth Ave, Denver, CO 80262 (Dr Carter).


Am J Dis Child. 1990;144(11):1225-1228. doi:10.1001/archpedi.1990.02150350057024.
Text Size: A A A
Published online
Article
References
Comments

• We retrospectively reviewed clinical and echocardiographic data on 10 new-borns with erythroblastosis fetalis who were admitted to our nurseries between 1984 and 1988 and who required a doublevolume exchange transfusion and neonatal intensive care. Echocardiograms were performed in the first 48 hours of life. In 5 patients, disproportionate septal hypertrophy was demonstrated; 1 additional patient had biventricular hypertrophy with a thickened septum but not disproportionate septal hypertrophy. The mean septal: left ventricular free-wall ratio for the group (n=10) was 1.37. No correlation was apparent between the occurrence of disproportionate septal hypertrophy and new-born glucose, bilirubin, or hematocrit values. When analyzed separately, the 4 patients who did not receive intrauterine blood transfusions had a ratio of 1.73 ± 0.21 (mean ± SEM); this was significantly greater than the ratio in the 6 patients who were transfused in utero (1.13±0.24). In patients who underwent transfusions, there was no correlation between the number of transfusions and the septal:left ventricular ratio. This study reports a significant but previously unrecognized cardiac hypertrophy with disproportionate septal hypertrophy in patients with erythroblastosis fetalis. Our data suggest a sparing effect of intrauterine fetal transfusions. The mechanism by which these transfusions may affect the hypertrophic development of the myocardium remains to be determined.

(AJDC. 1990;144:1225-1228)

REFERENCES

1 +
Gutgesell HP, Mullins CE, Gillette PG, Speer M, Rudolph AJ, McNamara DG.  Transient hypertrophic subaortic stenosis in infants of diabetic mothers . J Pediatr . 1976;;89:120-125.
2 +
Wolfe RR, Way GL.  Cardiomyopathies in infants of diabetic mothers . Johns Hopkins Med J . 1977;;140:177-180.
3 +
Gutgesell HP, Speer ME, Rosenberg HS.  Characterization of the cardiomyopathy in infants of diabetic mothers . Circulation . 1980;;61:441-449.
4 +
Breitweser JA, Meyer RA, Sperling MA, Tsang RC, Kaplan S.  Cardiac septal hypertrophy in hyperinsulinemic infants . J Pediatr . 1980;;96:535-539.
5 +
Naeye RL.  New observations in erythroblastosis fetalis . JAMA . 1967;;200:105-110.
6 +
Barrett CT, Oliver TK.  Hypoglycemia and hyperinsulinism in infants with erythroblastosis fetalis . N Engl J Med . 1968;;278:1260-1263.
7 +
van Assche FA, Gepts W, deGasparo M, Renaer M.  The endocrine pancreas in erythroblastosis fetalis . Biol Neonate . 1970;;15:176-185.
8 +
Liley AW.  Liquor amnii analysis in the management of the pregnancy complicated by rhesus sensitization . Am J Obstet Gynecol . 1961;;82:1359-1370.
9 +
Feigenbaum H. Echocardiography . Philadelphia, Pa: Lea & Febiger; 1986;:520.
10 +
Brown G, Brown R, Hey E.  Fetal hyperinsulinism in rhesus isoimmunization . Am J Obstet Gynecol . 1978;;131:682-686.
11 +
Schiff D, Lowy C.  Hypoglycemia and excretion of insulin in urine in hemolytic disease of the newborn . Pediatric Res . 1970;;4:280-285.
12 +
From GLA, Driscoll SG, Steinke J.  Serum insulin in newborn infants with erythroblastosis fetalis . Pediatrics . 1969;;44:549-553.
13 +
Raivio KO, Osterlund K.  Hypoglycemia and hyperinsulinemia associated with erythroblastosis fetalis . Pediatrics . 1969;;43:217-225.
14 +
Steinke J, Gries FA, Driscoll SG.  In vitro studies of insulin inactivation with reference to erythroblastosis fetalis . Blood . 1967;;30:359-363.
15 +
Freinkel N, Goodner CJ.  Carbohydrate metabolism in pregnancy, I: the metabolism of insulin by human placental tissue . J Clin Invest . 1960;; 39:116-131.
16 +
Stevens J, Whitsett JA.  Insulin binding to neonatal human, guinea pig and rat myocardial membranes . Pediatr Res . 1979;;13:482. Abstract.
17 +
Milley JR.  The effect of chronic hyperinsulinemia on ovine fetal growth . Growth Dev Aging . 1986;;50:390-401.
18 +
Thorsson AV, Hintz RL.  Insulin receptors in the newborn . N Engl J Med . 1977;;297:908-912.
19 +
Neufeld ND, Kaplan SA, Lippe BM.  Insulin binding studies in normal infants and infants of diabetic mothers . Pediatr Res . 1978;;12:397. Abstract.
20 +
Nuchpuckdee P, Brodsky N, Porat R, Hurt H.  Ventricular septal thickness and cardiac function in neonates after in utero ritodrine exposure . J Pediatr . 1986;;109:687-691.
21 +
Grampa G, Gargantini L, Grigolato PG, Chiumello G.  Hypoglycemia in infancy caused by beta cell nesidioblastosis . AJDC . 1974;;128:226-231.
22 +
Procianoy RS, Pinheiro CAE.  Neonatal hyperinsulinism after short-term maternal beta sympathomimetic therapy . J Pediatr. 1982;;101:612-614.
23 +
Procianoy RS, Cecin SKG.  High insulin cord levels in LGA infants born to non-diabetic, nonobese mothers . Pediatr Res . 1989;;25:228. Abstract.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

References

1 +
Gutgesell HP, Mullins CE, Gillette PG, Speer M, Rudolph AJ, McNamara DG.  Transient hypertrophic subaortic stenosis in infants of diabetic mothers . J Pediatr . 1976;;89:120-125.
2 +
Wolfe RR, Way GL.  Cardiomyopathies in infants of diabetic mothers . Johns Hopkins Med J . 1977;;140:177-180.
3 +
Gutgesell HP, Speer ME, Rosenberg HS.  Characterization of the cardiomyopathy in infants of diabetic mothers . Circulation . 1980;;61:441-449.
4 +
Breitweser JA, Meyer RA, Sperling MA, Tsang RC, Kaplan S.  Cardiac septal hypertrophy in hyperinsulinemic infants . J Pediatr . 1980;;96:535-539.
5 +
Naeye RL.  New observations in erythroblastosis fetalis . JAMA . 1967;;200:105-110.
6 +
Barrett CT, Oliver TK.  Hypoglycemia and hyperinsulinism in infants with erythroblastosis fetalis . N Engl J Med . 1968;;278:1260-1263.
7 +
van Assche FA, Gepts W, deGasparo M, Renaer M.  The endocrine pancreas in erythroblastosis fetalis . Biol Neonate . 1970;;15:176-185.
8 +
Liley AW.  Liquor amnii analysis in the management of the pregnancy complicated by rhesus sensitization . Am J Obstet Gynecol . 1961;;82:1359-1370.
9 +
Feigenbaum H. Echocardiography . Philadelphia, Pa: Lea & Febiger; 1986;:520.
10 +
Brown G, Brown R, Hey E.  Fetal hyperinsulinism in rhesus isoimmunization . Am J Obstet Gynecol . 1978;;131:682-686.
11 +
Schiff D, Lowy C.  Hypoglycemia and excretion of insulin in urine in hemolytic disease of the newborn . Pediatric Res . 1970;;4:280-285.
12 +
From GLA, Driscoll SG, Steinke J.  Serum insulin in newborn infants with erythroblastosis fetalis . Pediatrics . 1969;;44:549-553.
13 +
Raivio KO, Osterlund K.  Hypoglycemia and hyperinsulinemia associated with erythroblastosis fetalis . Pediatrics . 1969;;43:217-225.
14 +
Steinke J, Gries FA, Driscoll SG.  In vitro studies of insulin inactivation with reference to erythroblastosis fetalis . Blood . 1967;;30:359-363.
15 +
Freinkel N, Goodner CJ.  Carbohydrate metabolism in pregnancy, I: the metabolism of insulin by human placental tissue . J Clin Invest . 1960;; 39:116-131.
16 +
Stevens J, Whitsett JA.  Insulin binding to neonatal human, guinea pig and rat myocardial membranes . Pediatr Res . 1979;;13:482. Abstract.
17 +
Milley JR.  The effect of chronic hyperinsulinemia on ovine fetal growth . Growth Dev Aging . 1986;;50:390-401.
18 +
Thorsson AV, Hintz RL.  Insulin receptors in the newborn . N Engl J Med . 1977;;297:908-912.
19 +
Neufeld ND, Kaplan SA, Lippe BM.  Insulin binding studies in normal infants and infants of diabetic mothers . Pediatr Res . 1978;;12:397. Abstract.
20 +
Nuchpuckdee P, Brodsky N, Porat R, Hurt H.  Ventricular septal thickness and cardiac function in neonates after in utero ritodrine exposure . J Pediatr . 1986;;109:687-691.
21 +
Grampa G, Gargantini L, Grigolato PG, Chiumello G.  Hypoglycemia in infancy caused by beta cell nesidioblastosis . AJDC . 1974;;128:226-231.
22 +
Procianoy RS, Pinheiro CAE.  Neonatal hyperinsulinism after short-term maternal beta sympathomimetic therapy . J Pediatr. 1982;;101:612-614.
23 +
Procianoy RS, Cecin SKG.  High insulin cord levels in LGA infants born to non-diabetic, nonobese mothers . Pediatr Res . 1989;;25:228. Abstract.

Correspondence

Submit a Letter
CME
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Clear Answers | Save For Later
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s “Cited By” API will populate this tab (http://www.crossref.org/citedby.html).
Compression-Only CPR: Pushing the Science Forward
Cone
AAM 2010;304:1493-1495.
All you need to read in the other general journals
BMJ 2010;341:c5893-c1494.
Submit a Comment

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

© 2013 American Medical Association. All Rights Reserved.
Powered bySilverchair Information Systems