A 1-Hour-Old Boy in the Newborn Nursery Has Jitteriness and Irritability

A 1-hour-old boy in the newborn nursery has jitteriness and irritability.  His serum glucose is 21 mg/dL.  The infant was born by cesarean delivery for macrosomia and failure to progress.  The infant has not yet breastfed as his mother is still recovering from surgery.  He weighs 4.5 kg (9 lb 15 oz) .  His mother was prescribed insulin for gestational diabetes but has not taken it regularly.  She also has a history of depression and intravenous drug use.  She denies use of illicit drugs during the pregnancy and tested negative for HIV and hepatitis B and C in her third trimester.  Which of the following factors is the most likely cause of this neonate's hypoglycemia?

A) Beta cell hyperplasia
B) Glycogen storage disease
C) Hypothyroidism
D) Increased insulin-like growth factor 2 level
E) Placental transfer of insulin

Correct Answer:

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