What maternal disease is most likely to cause lethargy, tachycardia, and ventricular hypertrophy in a newborn, given options including Glycogen Storage Disease (GSD), Systemic Lupus Erythematosus (SLE), Diabetes, and Graves' disease?

Maternal Diabetes is the Most Likely Cause

Maternal diabetes is the most likely maternal disease causing lethargy, tachycardia, and ventricular hypertrophy in this newborn. 1

Pathophysiology of Diabetic Cardiomyopathy in Newborns

• Transient ventricular hypertrophy occurs in infants of diabetic mothers even after good diabetic control during pregnancy, representing a metabolic cause that typically resolves over time without specific intervention 1, 2
• Cardiac hypertrophy is reported in 13 to 44% of infants of diabetic mothers, making this a common and well-recognized complication 3
• The mechanism involves hyperinsulinism-induced cardiac hypertrophy, which cannot be distinguished from other forms of hypertrophic cardiomyopathy on echocardiographic examination alone 3
• Lysosomal glycogen accumulation results in significant cardiac hypertrophy that may begin in utero and is significant even at 4-8 weeks of age 1

Clinical Presentation Matches This Case

• Infants with diabetic cardiomyopathy present with lethargy and tachycardia as signs of acute congestive heart failure, which aligns with this newborn's presentation 4
• The ventricular hypertrophy can be substantial (between 2 and 10 or higher z-score for LV mass) 1
• These infants may show signs of marked congestive heart failure with non-dilated ventricular cavities and normal or increased left ventricular contractility 5

Why Other Options Are Less Likely

Glycogen Storage Disease (e.g., Pompe Disease)

• While Pompe disease causes severe cardiac hypertrophy in infants, it is not a maternal disease but rather an inherited metabolic disorder 1
• The question specifically asks for a maternal disease affecting the newborn 1

Systemic Lupus Erythematosus (SLE)

• Maternal SLE primarily causes congenital heart block in newborns, not ventricular hypertrophy 1
• The clinical presentation of lethargy, tachycardia, and hypertrophy does not match the typical neonatal lupus syndrome pattern 1

Graves Disease

• Neonatal hyperthyroidism from maternal Graves disease causes sinus tachycardia but not typically ventricular hypertrophy 1
• The primary cardiac manifestation would be tachycardia without structural changes 1

Diagnostic Confirmation

• Echocardiography is essential to assess the degree of ventricular hypertrophy, with LV mass evaluated by two-dimensional measurements using the length-area relationship 1
• Check maternal glucose control history and infant's glucose levels to confirm hyperinsulinism 3
• The absolute mass value should be compared to a normal control population to yield a z-score 1

Prognosis and Management

• The prognosis is generally favorable, as this form of cardiac hypertrophy typically resolves spontaneously during the first year of life 1, 2
• Serial echocardiographic monitoring is recommended to document resolution of hypertrophy 1
• Treatment focuses on managing any acute heart failure symptoms while awaiting spontaneous resolution 3
• Avoid inappropriate use of standard cardiomyopathy drugs, as they may worsen an already compromised heart in this specific context 1