Infant of Diabetic Mother

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Infant of Diabetic Mother

• 9/4/2005

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Infant of diabetic mother

• Introduction
• Pathophysiology
• Presentation clinical manifestations
• Prognosis
• treatment

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IDM

• Diabetic mothers have high risk pregnancies
• Fetal mortality rate is higher at all gestational
  ages
• Fetal loss throughout pregnancy is associated
  with uncontrolled diabetes in the mother
• LGA IUGR

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Pathophysiology

• Maternal hyperglycemia leads to fetal
  hyperglycemia.
• Hyperinsulinemia
• Pathological findings
• Hypertrophy hyperplasia of pancreatic cells
• Increase wt of placenta infant organs
• Extramedullary hematopoeisis
• Still birth
• Hypoglycemia after birth

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Pathophysiology

• Hyperinsulinemia in both GDM IDDM
• Response to glucose arginine
• Hyperinsulinism diminished catecholamine
  respnonse
• Cortisole hGH are normal
• Poor control in the periconceptual period leads
  to congenital anomalies

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Clinical manifestations

• Large plump
• Puffy plethoric
• May be normal, or have low birth wt.
• Hypoglycemia 25-50 of IDM , 15-25 of IGDM.
• The lowest glucose level 1-3hrs , spontaneous
  recovery 4-6
• Jumpy , hyperexcitable or lethargic , hypotonic.

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• Hypocalcemia
• Hypomagnesemia
• Tachypnea in the first 2 days
• Hypoglycemia
• Hypothermia
• Polycythemia
• Cardiac failure
• TTN
• Cerebral edema
• Higher incidence of RDS

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• Crdiomegaly 30
• Heart failure 5-10
• Asymmetric septal hypertrophy inotropic agents
  are contraindicated
• Birth trauma
• Immature neurologic development
• Delay in ossification centers
• Hyperbilirubenemia
• Renal vein thrombosis

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• Incidence of cngenital anomalies is increased 3
  fold
• Cardiac anomalies
• Lumbosacral agenesis
• Neural tube defects
• Hydronephrosis , renal agenesis
• Duedenal, anorectal atresia
• Situs inversus
• Holoprosencephaly
• Small left colon syndrome

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prognosis

• Incidence of diabetes mellitus is increased in
  IDM
• Physical development is normal
• Obesity
• Impaaired intellectual development????
• Hypoglycemia
• Maternal ketonuria

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Treatment

• Frequent prenatal evaluation of mothers at risk.
• Fetal evaluation
• Delivery planning
• Periconceptual glucose control,control during
  labor
• GDMglyburide vs. insulin

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Treatment

• Close observation regardless of birth weight

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Hypoglycemia

• AsymptomaticBlood glucose levels within 1st
  hr, then hrly for 6-8 hrs, if normoglycemic start
  feeding ASAP ( oral or NG)
• If feeding unsuccessful IV glucose 4-8 mg/kg/min

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• Hypoglycemia should be treated whether
  symptomatic or not feeding /or IV glucose.
• Hypertonic glucose should be avoided.
• Symptomatic( convulsions, tremors,
  cyanosis,apneic spells,eye rolling , difficult
  feeding sweating, hypothermia, lethargy)
• IV bolus of 200mg/kg ( 2cc/kg of DW 10), if
  seizures 4mg/kg to be given.
• IV infusion at rate of 8mg/kg/min

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• If inadequate concentration can go up to 20 .
• Hydrocortisone 5mg/kg/day , BID, IM
• Crystalline glucagon IM or SQ
• If still inadequate diazoxide
• Octreotide
• Measure glucose hrly then Q 4-6 hrs
• Never abruptly stop IV glucose infusion.
  reactive hypoglycemia

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• Hypoglycemia usually resolves within 24 hrs
• Persistent hypoglycemia persistent
  hyperinsulinemia
• If more than 7 days consider other causes

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Hypocalcemia

• Found In 22 of IDM
• The nadir 24-72 hrs
• Total serum calcium below 7 mg/dl
• In well babies resolves without treatment
• Treatment may be necessery unable to feed ,
  symptomatic , has a coexisting illness.

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Thank you !