症例は在胎38週 6 日，体重3，116gで出生した男児．日齢 7 に退院し，退院時体重は2，914gだった．日齢 9 に保健師訪問の際体重2，845gと体重減少を認め，前医を受診，その際に血糖値658mg/dLと著明な高血糖を認め，精査・加療目的に当院紹介となった．新生児糖尿病と診断し経静脈的持続インスリン注入療法により治療を開始し，血糖値は改善した．後日，入院時に依頼した遺伝子解析の結果6q24メチル化異常が判明した．新生児の体重増加不良には様々な原因があるが，その精査の過程において血糖値の測定は必須の検査である．低栄養状態を反映して血糖低値が予測されることが多いが，本症例のように稀に高血糖から新生児糖尿病が判明する場合もあることを念頭に置く必要がある.
8 ）Okuno M，Yorifuji T，Kagami M，et al: Chromosome
1 ）Nagashima K，Tanaka D，Inagaki N: Epidemiology，
6q24 methylation defects are uncommon in childhood-
clinical characteristics，and genetic etiology of neonatal
onset non-autoimmune diabetes mellitus patients born
diabetes in Japan．Pediatr Int，59（ 2 ）: 129-133，2017．
appropriate- or large-for-gestational age．Clin Pediatr
2 ）小児慢性特定疾病情報センター
Endocrinol，25（ 3 ）
: 99-102，2016．
Abstract
A CASE OF NEONATAL DIABETES MELLITUS DETECTED
BY POOR WEIGHT GAIN
Hirota TAKASHIMA 1 , 2 ）, Yoko TSURUOKA 1 , 3 ）, Keita NUMASAWA 1 ）,
Kentaro SHIGA 1 ）, Tohru YORIFUJI 4 ）
1）
Children’s Medical Center, Yokohama City University Medical Center
2）
Department of Pediatrics, Yokohama City Minato Red Cross Hospital
3）
4）
Department of Pediatrics, Fujisawa City Hospital
Division of Pediatric Endocrinology and Metabolism, Children’s Medical Center, Osaka City General Hospital
A boy was born at 38 weeks and 6 days of gestation, weighing 3,116 g. He was discharged from the hospital at the
age of 7 days and weighed 2,914 g at the time of discharge. At the age of 9 days, when a public health nurse visited
him, he had lost weight, weighing 2,845 g. He was therefore seen by a doctor. He was found to have marked
hyperglycemia with blood glucose of 658 mg/dL and was referred to our hospital for detailed examination and
treatment. The patient was diagnosed as having neonatal diabetes mellitus and started on treatment with intravenous
continuous insulin infusion, and the blood glucose level improved. Gene analysis requested at the time of admission
later showed abnormal 6q24 methylation. There are various causes of poor weight gain in neonates, and measurement
of the blood glucose level is an essential test in the process of investigating the cause. Although low blood glucose
levels are often predicted to reflect poor nutritional status, it is important to keep in mind that neonatal diabetes
mellitus may be detected by hyperglycemia in rare cases, as in the present case.
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