A metabolomic approach in an experimental model of hypoxia-reoxygenation in newborn piglets: urine predicts outcome

Perinatal asphyxia is one of the leading causes of morbidity and mortality in the neonatal period. Response to oxygen treatment is unpredictable and the optimum concentration of oxygen in neonatal resuscitation is still a matter of debate among neonatologists. A metabolomic approach was used to characterize the metabolic profiles of newborn hypoxic-reoxygenated piglets. Urine samples were collected from newborn piglets (n = 40) undergoing hypoxia followed by resuscitation at different oxygen concentrations (ranging from 18% to 100%) and analyzed by ¹H NMR spectroscopy. Despite reoxygenation 7 piglets, out of 10 which became asystolic, did not respond to resuscitation. Profiles of the ¹H NMR spectra were submitted to unsupervised (principal component analysis) and supervised (partial least squares-discriminant analysis) multivariate analysis. The supervised analyses showed differences in the metabolic profile of the urine collected before the induction of hypoxia between survivors and deaths. Metabolic variations were observed in the urine of piglets treated with different oxygen concentrations comparing T0 (basal value) and end of the experiment (resuscitation). Some of the individual metabolites discriminating between these groups were urea, creatinine, malonate, methylguanidine, hydroxyisobutyric acid. The metabolomic approach appears a promising tool for investigating newborn hypoxia over time, for monitoring the response to the treatment with different oxygen concentrations, and might lead to a tailored management of the disorder.

Long-term effects of neonatal drugs on the kidney

Several drugs have been shown to produce an adverse affect on kidneys, mainly when exposure occurred during active nephrogenesis (pregnancy or prematurity). Several experimental studies on drug-related renal injury have been done on animal models. Observational reports on early drug-related nephrotoxicity in humans are increasing. The investigations regard nephrotoxicity from antibiotics (particularly aminoglycosides), angiotensin-converting enzyme (ACE) inhibitors, non-steroidal anti-inflammatory drugs and antifungins. Few reports have been specifically on the long-term effects on kidneys of drugs given to newborns during active nephrogenesis. Most observations were targeted to investigate long-term renal effects of prematurity and intrauterine growth retardation (IUGR). Nephrotoxic medication taken during fetal life and during postnatal nephrogenesis could interfere with nephron generation contributing to a particular magnitude of damage. Such adjunctive damage could further increase the risk of renal failure in the adulthood of children born prematurely.

Isoprostane levels in urine of preterm newborns treated with ibuprofen for patent ductus arteriosus closure

Patent ductus arteriosus (PDA) is the most common cardiovascular abnormality of the preterm infant usually treated with ibuprofen (IBU). PDA is strictly related to oxidative stress (OS) in neonates. This study tests the hypothesis that OS occurs in neonates with PDA and that IBU treatment reduces OS. Forty-three preterm babies with gestational age (GA) <33 weeks were studied prospectively. Three urine samples were collected: at time 0 (before starting treatment), time 1 (after pharmacological PDA closure), and time 2 (7 days after the end of treatment) in all patients. OS was studied by measuring urinary isoprostane (IPs) levels. The results showed significant changes in urinary IP levels from time 0 to time 2 (Kruskal-Wallis, p=0.047). Time trend showed a significant decrease in IPs from time 0 to time 1 after IBU therapy (p=0.0067). This decrease was followed by an increase in IPs levels 7 days after treatment. IBU therapy for PDA closure reduced the risk of OS related to free-radical (FR) generation. This antioxidant effect of IBU may be beneficial in preterm babies with PDA who are at high risk for OS.

Bronchiolitis-associated encephalopathy in critically-ill infants: an underestimated complication?

OBJECTIVE

To investigate the bronchiolitis-associated encephalopathy in critically ill infants.

METHODS

The records of infants with severe bronchiolitis admitted to our intensive care unit between 1991 and 2003 were reviewed. Subjects with underlying neurological disorders were excluded. Encephalopathy was defined as occurrence of seizures or at least two nonconvulsive neurologic manifestations. A semistructured telephone interview investigated long-term neurodevelopmental outcome.

RESULTS

Twenty-one infants (11 newborns) were enrolled. All patients required oxygen supplementation and 14 required mechanical ventilation. Encephalopathy occurred in 10 infants, six of whom developed seizures. Encephalopathic infants frequently (six of nine) showed transient EEG abnormalities, and occasionally (one of nine) cranial ultrasound abnormalities. A positive respiratory syncytial virus test was found in five of nine encephalopathic infants. One encephalopathic patient died, while 20 infants clinically normalised before discharge and showed a good neurodevelopmental outcome.

CONCLUSIONS

Acute encephalopathy was frequently observed in our patients with severe bronchiolitis. Long-term prognosis of encephalopathic infants was good.

Metabolomics: the "new clinical chemistry" for personalized neonatal medicine

Metabolomics is a new approach based on the systematic study of the full complement of metabolites in a biological sample. This technology consists of two sequential steps: (1) an experimental technique, based on mass spectrometry or nuclear magnetic resonance (NMR) spectroscopy, designed to profile low molecular weight compounds, and (2) multivariate data analysis. Metabolomic analysis of biofluids or tissues has been successfully used in the fields of physiology, diagnostics, functional genomics, pharmacology, toxicology and nutrition. Recent studies have evaluated how physiological variables or pathological conditions can affect metabolomic profiles of different biofluids in pediatric populations. Little is known about the overall metabolic status of the term and preterm neonate. On the other hand, the management of sick or preterm newborns might be improved if more information on perinatal/neonatal maturational processes and their metabolic background were available. At present, the use of metabolomics in Neonatology is still in the pioneering phase. Meaningful diagnostic information and simple, non-invasive collection techniques make urine a particularly suitable biofluid for metabolomic approach in neonatal medicine. Using NMR-based metabolomic analysis of urine, distinct metabolic patterns have been shown to be associated with different classes of gestational age in a population of preterm and term infants. Together with genomics and proteomics, metabolomics appears to be a promising tool in Neonatology for the monitoring of postnatal metabolic maturation, the identification of biomarkers as early predictors of outcome, the diagnosis and monitoring of various diseases and the "tailored" management of neonatal disorders.

Ibuprofen and acute kidney injury in the newborn

The pharmacological treatment of patent ductus arteriosus (PDA) in preterm infants remains a controversial issue, particularly with regard to the type of drug to be prescribed (ibuprofen or indomethacin) and the timing of the treatment, given their comparable effectiveness. For many years, indomethacin has been the drug of choice in the treatment of PDA. In April 2006, the United States Food and Drug Administration approved the use of ibuprofen lysine for closure of clinically significant PDA in premature infants < 32 weeks' gestation and weighing 500-1500 g. The available knowledge on the effects of ibuprofen on renal function in the neonate is discussed herein, since the good renal tolerability of this drug is a major argument in favor of its use in the routine treatment of PDA.

The infant incubator in the neonatal intensive care unit: unresolved issues and future developments

Since the 19th century, devices termed incubators were developed to maintain thermal stability in low birth weight (LBW) and sick newborns, thus improving their chances of survival. Remarkable progress has been made in the production of infant incubators, which are currently highly technological devices. However, they still need to be improved in many aspects. Regarding the temperature and humidity control, future incubators should minimize heat loss from the neonate and eddies around him/her. An unresolved issue is exposure to high noise levels in the Neonatal Intensive Care Unit (NICU). Strategies aimed at modifying the behavior of NICU personnel, along with structural improvements in incubator design, are required to reduce noise exposure. Light environment should be taken into consideration in designing new models of incubators. In fact, ambient NICU illumination may cause visual pathway sequelae or possibly retinopathy of prematurity (ROP), while premature exposure to continuous lighting may adversely affect the rest-activity patterns of the newborn. Accordingly, both the use of incubator covers and circadian lighting in the NICU might attenuate these effects. The impact of electromagnetic fields (EMFs) on infant health is still unclear. However, future incubators should be designed to minimize the EMF exposure of the newborn.

1H NMR-based metabolic profiling of urine from children with nephrouropathies

Pediatric nephrourological diseases are associated with functional alterations frequently related to inflammatory states. A feedback loop adjusts urinary system function while forcing adaptation to internal and external influences during disease development and as a result of treatment. We hypothesized that nephrourological dysfunction would alter the urine metabolite pattern in children in a defined manner. To characterize the metabolite patterns associated with nephrouropathies, a proton nuclear magnetic resonance (1H NMR)-based metabonomic analysis was performed on urine samples obtained from twenty-one children affected by nephrouropathies and 19 healthy controls. Urine samples were analyzed with a 400 MHz Varian spectrometer and multivariate statistical techniques were applied for data interpretation. Linear discriminant analysis-based classification of the spectral data demonstrated high accuracy (95 per cent) in the separation of the two groups of samples. The urine metabolite profiles were shown to correlate with nephrourological disorders in our model. In conclusion, 1H NMR-based metabonomic analysis of urine appears to be a promising, non-invasive approach to investigate and monitor pediatric nephrourological diseases.

Immunoreactivity to glial cell line-derived neurotrophic factor and its receptors in the trout pancreas: a further endocrine-exocrine relationship?

Glial cell line-derived neurotrophic factor (GDNF) is a growth factor promoting the survival of several neuronal populations in the central, peripheral and autonomous nervous system. Outside the nervous system, GDNF functions as a morphogen in kidney development and regulates spermatogonial differentiation. GDNF exerts its roles by binding to glial cell line-derived neurotrophic factor receptor (GFR) a1, which forms a heterotetramic complex with rearranged during transfection (RET) proto-oncogene product, a tyrosine kinase receptor. In this study we report the presence of GDNF-, RET- and GFRa1-like immunoreactivity in the pancreas of juvenile trout. GDNF immunoreactivity was observed in the islet cells, while GFRa1- and RET- immunoreactivity was observed in the exocrine portion. These findings suggest a paracrine role of GDNF towards exocrine cells showing GDNF receptors GFRa1 and RET. The relationship could reflect physiological interactions, as previously indicated in mammalian pancreas, and/or a trophic role by endocrine cells on exocrine parenchyma, which shows a conspicuous increase during animal growth.

Urinary prostaglandin E2 in the newborn and infant

Prostaglandin E(2) (PGE(2)) belongs to a family of biologically active lipids derived from the 20-carbon essential fatty acids. Renal PGE(2) is involved in the development of the kidney; it also contributes to regulate renal perfusion and glomerular filtration rate, and controls water and electrolyte balance. Furthermore, this mediator protects the kidney against excessive functional changes during the transition from fetal to extrauterine life, when it counteracts the vasoconstrictive effects of high levels of angiotensin II and other mediators. There is evidence that PGE(2) plays an important pathophysiological role in neonatal conditions of renal stress, and in congenital or acquired nephropaties. Thus, measurement of urinary PGE(2) as an index of renal synthesis of this primary prostaglandin may represent a non-invasive and sensitive method of investigating the homeostatic function of the kidney in early life. The aim of this literature review is to examine urinary PGE(2) as a non-invasive marker of renal homeostasis in the newborn and infant under both physiological and pathological conditions, or during treatments with widely used, potentially toxic drugs.

Circulating haemopoietic and endothelial progenitor cells are decreased in COPD

Circulating CD34+ cells are haemopoietic progenitors that may play a role in tissue repair. No data are available on circulating progenitors in chronic obstructive pulmonary disease (COPD). Circulating CD34+ cells were studied in 18 patients with moderate-to-severe COPD (age: mean+/-sd 68+/-8 yrs; forced expiratory volume in one second: 48+/-12% predicted) and 12 controls, at rest and after endurance exercise. Plasma concentrations of haematopoietic growth factors (FMS-like tyrosine kinase 3 (Flt3) ligand, kit ligand), markers of hypoxia (vascular endothelial growth factor (VEGF)) and stimulators of angiogenesis (VEGF, hepatocyte growth factor (HGF)) and markers of systemic inflammation (tumour necrosis factor (TNF)-alpha, interleukin (IL)-6, IL-8) were measured. Compared with the controls, the COPD patients showed a three-fold reduction in CD34+ cell counts (3.3+/-2.5 versus 10.3+/-4.2 cells.microL-1), and a 50% decrease in AC133+ cells. In the COPD patients, progenitor-derived haemopoietic and endothelial cell colonies were reduced by 30-50%. However, four COPD patients showed progenitor counts in the normal range associated with lower TNF-alpha levels. In the entire sample, CD34+ cell counts correlated with exercise capacity and severity of airflow obstruction. After endurance exercise, progenitor counts were unchanged, while plasma Flt3 ligand and VEGF only increased in the COPD patients. Plasma HGF levels were higher in the COPD patients compared with the controls and correlated inversely with the number of progenitor-derived colonies. In conclusion, circulating CD34+ cells and endothelial progenitors were decreased in chronic obstructive pulmonary disease patients and could be correlated with disease severity.

Acute encephalopathy associated with respiratory syncytial virus infections in childhood. A literature review

Respiratory syncytial virus (RSV) has been described as the single most important virus causing acute respiratory infections, especially bronchiolitis and pneumonia, in children. The most severe infections affect the youngest infants and well-defined high-risk groups, including infants with a history of premature birth, and those with chronic lung disease, congenital heart disease, cystic fibrosis and immunodeficiency. It has been reported that approximately 1/3 of high-risk children hospitalized with RSV infection are admitted to the intensive care unit, while the need for mechanical ventilation and mortality rate are increased in infants with underlying cardiac disease or chronic lung disease. The majority of infants hospitalized for RSV lower respiratory tract infection develop one complication or more, which have an impact on hospital length of stay and costs. A relatively uncommon complication consisting of seizures and other neurologic abnormalities such as lethargy, irritability and abnormal tone has been sporadically reported in infants and children with RSV respiratory infection. A recent study first focused on the association between RSV bronchiolitis and an encephalopathic process occurring in the form of a seizures disorder. This transient neurologic complication seems to be frequently associated with an abnormal EEG pattern, but no anatomic brain damages have been shown. Little is known about the long-term neurodevelopmental outcomes of children developing RSV-related encephalopathy, so a prolonged period of neurologic follow up can be recommended.

Intrauterine smoke exposure: a new risk factor for bronchopulmonary dysplasia?

OBJECTIVE

To evaluate the role of intrauterine smoke exposure and other variables on the development of bronchopulmonary dysplasia (BPD) in infants with birth weight < 1500 g (VLBW).

METHODS

This case-control study investigated 277 VLBW infants (141 cases, 136 controls) admitted at birth to neonatal intensive care unit and survived to discharge. A retrospective telephone interview provided detailed parental information supplementing clinical data. Logistic regression assessed the effects of birth weight < 1000 g, gestational age < 30 weeks (GA<30), respiratory distress syndrome (RDS), neonatal mechanical ventilation > 7 days (MV>7), patent ductus arteriosus (PDA), intrauterine smoke exposure > or = 3 months (ISE), and of parental history of asthma on BPD (oxygen dependency at 28 days with characteristic radiographic abnormalities) occurrence.

RESULTS

Including all variables, only GA<30, RDS and MV>7 were significantly associated with BPD. ISE did not contribute significantly to this model (odds ratio [OR] 1.94; 95% confidence interval 0.88-4.26). Excluding iatrogenic variable MV>7, GA<30, RDS, PDA and ISE (OR 2.21; 95% confidence interval 1.03-4.76) were significantly associated with BPD. Analyzing GA as a continuous variable, the OR was 0.63 for each additional week.

CONCLUSIONS

Prolonged mechanical ventilation, RDS and low gestational age were the major BPD determinants. Intrauterine smoke exposure seems to influence independently BPD development.

Water and sodium imbalance in COPD patients

Water retention and hyponatraemia are typically observed in the final stages of Chronic Obstructive Pulmonary Disease (COPD) and the onset of edema is a poor prognostic factor. For several years the pathogenesis of edema in COPD patients was attributed to heart impairment because of pulmonary hypertension, but the evidence that cardiac output is often adequate for the metabolic demands has suggested, since 1960, that the pathogenesis of edema in these patients would be correlated with gas exchange impairment and in particular with carbon dioxide (CO2) retention. The gas exchange impairment induces, in these patients several hormonal abnormalities: renin (Rn), angiotensin II (AnII), aldosterone (Ald), atrial natriuretic peptide (ANP), vasopressin (ADH) and endothelial factors are some of the factors involved. The systemic response to hypercapnia has the effect of reducing the renal blood flow and, as a result, increasing water and sodium retention with the final effect of edema and hyponatraemia. The aim of this brief review is to highlight the current knowledge on renal/hormonal abnormalities in COPD and their therapeutic implications.

Exercise physiology in COPD

Multiple mechanisms contribute to exercise limitation in chronic obstructive pulmonary disease (COPD). The ability to increase ventilation during exercise is reduced; the more advanced the disease, the more impaired the exercise tolerance is. However, factors other than ventilatory limitation play an important role in reducing the exercise capacity in COPD. Data implicating peripheral muscle atrophy and muscle weakness as cofactors have been reported in individuals with advanced disease. At this stage daily activities are curtailed to avoid exertional respiratory discomfort. Recent studies have demonstrated that the muscle aerobic capacity of stable hypoxemic COPD patients is impaired; oxygen uptake (V'O2) kinetics and 31P magnetic resonance spectroscopy studies have shown that these patients rely heavily on non-aerobic energy sources even during moderate, sustained workloads. Finally, early occurrence of metabolic acidosis has been demonstrated in patients with mild to severe COPD during exercise. Inadequate tissue oxygenation appears to result from a defect in peripheral oxygen utilization rather than from a reduction in O2 bulk flow. Peripheral factors may include: a) impaired diffusive conductance for O2 between red cells and mitochondria; b) heterogeneous distribution of O2 bulk flow within the exercising muscle fibers; c) inertia of the oxidative processes at the cellular level; d) changes in distribution of muscle fibers, e) reduction in muscle aerobic enzymes; and f) poor nutritional status. Since muscle dysfunction has an important role in the development of exercise intolerance, physical rehabilitation is more and more used as part of the treatment of COPD. The aim of this review is to briefly discuss current views on the mechanisms responsible for the reduced ability to exercise and the rationale for exercise rehabilitation in COPD patients.

Skeletal muscle dysfunction in chronic obstructive pulmonary disease

During the last decade evidence has been accumulated on the role of skeletal muscle dysfunction in reducing exercise capacity and affecting the quality of life of patients with chronic obstructive pulmonary disease (COPD). An appreciable body of research has helped to identify morphological and biochemical alterations, physiological consequences, and possible therapeutic interventions. There are, however, still many areas of uncertainty. For example it is not clear how much of the alterations are within the muscle itself or the consequence of the altered environment in which the muscle works. Similarly it is not clear how much of the impairment is simply due to aging and chronic inactivity. Another key issue is the possible additive effect of drugs often used in COPD patients, such as steroids, beta 2-agonist and cyclosporin. A specific additional layer of complexity comes from nutritional considerations and in particular loss of muscle mass which not infrequently accompanies severe disease and even greater exercise intolerance. Studies on the effects of training or other therapeutic interventions have shown that muscle dysfunction is partially reversible. There is, however, a clear need for studies based on cellular and molecular methods aimed to clarify the role of factors such as oxidative stress, inflammation and nutritional deficiencies on skeletal muscle structure and function. The focus of this review is to highlight the current knowledge on skeletal muscle dysfunction in COPD and briefly summarize the possible therapeutic implications.

VIP-like immunoreactivity in the intestinal tract of fish with different feeding habits

We studied the distribution of vasoactive intestinal polypeptide immunoreactive (VIP-ir) cells and fibres in the intestine of three fish species with different feeding habits: the silver carp (Hypophthalmichthys molitrix), the goldfish (Carassius auratus), and the pumpkinseed sunfish (Lepomis gibbosus). Each species was divided into two groups: (1) fish fed once a day up until sacrifice and (2) fish fed once a day and then fasted three days before sacrifice. Immunoreactive endocrine cells and fibres were present in all three fish species. The immunoreactive cells were distributed along the entire intestinal mucosa of the carp and goldfish but were found only in the anterior intestine of the sunfish. The immunoreactive fibres were present along the entire intestinal wall, in the myenteric plexus, in the circular muscular layer, and in the connective tissue of the mucosa in all three fish species. No differences were found between the cells and fibres of normally-fed animals and the cells and fibres of fasted animals. The authors hypothesize that the different distributions of VIP-ir cells and fibres are related to the different contents of hard and indigestible matter of the fish food.

A water-vapour giga-maser in the active galaxy TXFS2226-184

Active galactic nuclei are thought to be powered by gas falling into a massive black hole; the different types of active galaxy may arise because we view them through a thick torus of molecular gas at varying angles of inclination. One way to determine whether the black hole is surrounded by a torus, which would obscure the accretion disk around the black hole along certain lines of sight, is to search for water masers, as these exist only in regions with plentiful molecular gas. Since the first detection of an extra-galactic water maser in 1979, they have come to be associated primarily with active galaxies, and have even been used to probe the mass of the central engine. Here we report the detection of a water giga-maser in the radio galaxy TXFS2226-184. The strength of the emission supports a recently proposed theory of maser pumping that allows for even more powerful masers, which might be detectable at cosmological distances. Water masers may accordingly provide a way to determine distances to galaxies outside the usual distance ladder, providing an independent calibration of the Hubble constant.

[The effect of cadmium on the intestine of Carassius auratus]

The paper deals with the cadmium effects on the intestinal mucosa of adult Carassius auratus after 7, 14 and 40 days of exposure. After 7 days the mucosa becomes oedematous; the mucous cells show intensive secretion. The cells showing immunoreactivity for the Met- and Leu-enkephalin miss this feature. After 14 days these modifications diminish and after 40 days disappear completely and the mucosa gains its normal characteristics.

Serum lipoprotein pattern as modified in G6PD-deficient children during haemolytic anaemia induced by fava bean ingestion

In the present study, plasma lipid concentrations were determined at different times after admission in sera from G6PD-deficient children during haemolytic crisis induced by fava bean ingestion. Reductions in total, LDL and HDL cholesterol were found in association with the maximum of bone marrow hyperplasia. A return towards normal values occurred with regression of the disease. No changes in other lipid parameters were observed. These data suggest that alterations of lipoprotein pattern, other than in experimental animals, are also present in humans with non-malignant proliferative processes. These changes appear to be a consequence of the disease, probably due to an increased utilization of cholesterol by proliferating cells.

[Immunohistochemical and ultrastructural study of endocrine cells from the pyloric region of the European mole (Talpa europaea)]

The distribution and the morphology of some endocrine cells (gastrin, somatostatin and 5-HT immunoreactive) in the pyloric region were studied in the Talpa europaea, an insectivore representing one of the most primitive living Eutherians. The immunohistochemical studies enabled us to identify and calculate the percentage of each cell type: the most numerous endocrine cells were gastrin immunoreactive; fairly numerous appeared somatostatin immunopositive; less numerous were 5-HT immunoreactive cells. While the ultrastructural observations let us describe four endocrine cell types: G cells producing gastrin, D cells containing somatostatin, EC cells of the gastric type producing 5-HT and D1 cells whose content is still unknown.

Enhancement of sickle erythrocyte adherence to endothelium by autologous platelets

The increased adhesiveness of sickle erythrocytes (SS RBC) to endothelial cells has been confirmed in a static system utilizing fresh umbilical vein endothelium. Adherence of SS RBC to the endothelium was as great in the presence of calcium-containing buffer as when incubated in plasma. SS RBC suspended in autologous platelet-rich plasma adhered to a greater extent than when suspended in autologous platelet poor plasma. Prostacyclin, thromboxane B2, and an inhibitor of collagen- and epinephrine-induced platelet aggregation (B13.177) did not affect SS RBC adherence to endothelium. Aspirin in a concentration of 5 micrograms/ml slightly decreased SS RBC adherence to endothelium in the presence of platelets. Platelets may play a significant role in the increased adhesiveness of SS RBC to endothelium. To the extent that increased SS RBC adhesiveness contributes to the genesis of painful crises and to the extent platelets augment this adhesiveness, agents affecting platelet function may prove useful in preventing painful crises.

[Duodenal ulcer in 2 dizygotic twins]

We report two cases of duodenal ulcer (DU) identified at endoscopy in a pair of dizygotic twins; their outstanding clinically recognizable features were a very early onset, a great familiar occurrence, a lack of triggering conditions (drugs, burns, stress, sepsis, respiratory distress), normal serum levels of gastrin and pepsinogen I, inadequate response to medical treatment with H2-receptor antagonists, but satisfactory response to associated therapy with H2-receptor antagonists and sucralfate. Results of this study show that examined twins were affected by a form of early-onset primary DU, probably inherited like an autosomal dominant disorder with high degree of penetrance, associated with normal serum pepsinogen I and gastrin; in this form of Du a decreased tissue resistance of duodenal mucosa is likely more important, pathogenically, than an increased peptic secretion. At present long-term prognosis of our patients is unknown.

[Wiedemann-Beckwith syndrome in childhood]

A follow up examination was carried out in a 10 year old child who had been diagnosed as having Wiedemann-Beckwith syndrome soon after birth. Macrosomy was seen to persist and body asymmetry and some dysmorphic aspects had become more pronounced over the years. The presence of moderate mental deficiency had led to difficulty in social relationships. In the prepuberty phase, the reappearance of hypoglycemia crises, which were also noted in the neonatal age, was of particular interest.