Open Access Case report

Rare neonatal diabetes insipidus and associated late risks: Case report

Maximiliano Francisco Rivas-Crespo1*, Lorena Miñones-Suárez1 and Susana Serrano G-Gallarza2

Author Affiliations

1 Department of Pediatrics, Hospital Universitario Central de Asturias, Oviedo, Spain

2 Neuroradiology, Hospital San Agustín, Avilés, Spain

For all author emails, please log on.

BMC Pediatrics 2012, 12:56  doi:10.1186/1471-2431-12-56

Published: 28 May 2012

Abstract

Background

Most cases of neonatal central diabetes insipidus are caused by an injury, which often results in other handicaps in the patient. The infant’s prognosis will be determined by his or her own early age and disability as well as by the physician’s skill. However, the rarity of this condition prevents the acquisition of personal experience dealing with it.

Case Presentation

A neonatal hemorrhagic stroke, caused by an aortic coarctation, caused right lower limb paresis, swallowing disability, and central diabetes insipidus in a term infant. The scant oral intake, as a consequence of his disability, caused progressive undernutrition which closed a vicious circle, delaying his development and his ability to overcome the swallowing handicap. On the other hand, nasal desmopressin absorption was blocked by several common colds, resulting in brain bleeding because of severe dehydration. This even greater brain damage hampered the improvement of swallowing, closing a second harmful circle. Moreover, a devastating central myelinolysis with quadriplegia, caused by an uncontrolled intravenous infusion, consummated a pernicious sequence, possibly unreported.

Conclusions

The child’s overall development advanced rapidly when his nutrition was improved by gastrostomy: This was a key effect of nutrition on his highly sensitive neurodevelopment. Besides, this case shows potential risks related to intranasal desmopressin treatment in young children.

Keywords:
At term newborn; Infant; Coarctation of the aorta; Neonatal intraventricular hemorrhage; Central diabetes insipidus; Neurodevelopmental delay; Undernutrition; Myelinolysis; Dehydration; Desmopressin