The aim of this study was to assess the association between perinatal status and insulin resistance in neonates during the birth period. The subjects were 49 neonates (27 boys, 22 girls) who had been admitted to the neonatal intensive care unit at Nihon University Itabashi Hospital within 2 h after birth. We retrospectively analyzed the associations between perinatal status (Apgar score, sex, gestational age, birth weight, etc.) and insulin resistance (assessed by plasma immunoreactive insulin (IRI), plasma cortisol, homeostatic model analysis ratio (HOMA-R), quantitative insulin sensitivity check index (QUICKI), plasma glucose/IRI ratio, and plasma IRI/cortisol ratio) based on the medical records. The preterm neonates had significantly lower plasma cortisol levels (P = 0.02) and significantly higher plasma IRI/cortisol ratios (P = 0.04) compared with the full-term neonates. No significant differences were found in any of the parameters between neonates with asphyxia and those without. In cases with hyperinsulinemia, male predominance was significant (P < 0.01) in neonates with hypoglycemia; furthermore, birth weight, HOMA-R, and plasma glucose/IRI ratio tended to be lower (P = 0.07, P = 0.01 and P < 0.01, respectively), while QUICKI and plasma IRI/cortisol ratio tended to be higher (P = 0.02 and P = 0.09, respectively) in neonates with hypoglycemia compared with those without. One possible reason for these findings could be the immaturity of the hypothalamic-pituitary-adrenal axis in preterm infants. There was no significant correlation between perinatal status and the indices of insulin resistance in neonates during the birth period.
A 14-year-old boy with hypertrophic cardiomyopathy experienced ventricular fibrillation while running in his schoolyard. He was resuscitated and admitted to our hospital. Delayed enhancement cardiac magnetic resonance imaging revealed asymmetric ventricular septal hypertrophy and delayed enhancement of the ventricular septum. Monomorphic ventricular tachycardia (VT) was induced by double ventricular extrastimuli. During electroanatomical mapping, a low voltage area was found in the right ventricle, but none was found in the left ventricular endocardium. Pace-mapping from the anterior right ventricular outflow tract, i.e., the low voltage area, revealed delayed potentials, and pacing at this site generated an 85% morphological match to the induced VT. Endomyocardial biopsy of the right ventricular septum revealed differences in myocyte size and myocardial disarray, along with moderate interstitial fibrosis. A cardioverter defibrillator (ICD) was implanted. Genetic testing identified a novel heterozygous missense mutation in the cardiac myosin heavy chain gene.