Infant Of Diabetic Mother...main reference is E Medicine...
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Transcript of Infant Of Diabetic Mother...main reference is E Medicine...
Any abnormal intolerance that begins or is
first recognized during pregnancy using
glucose tolerance test
Using 100 mg glucose load
Two or more of the plasma glucose
concentration must be met for the diagnosis.
Insulin level inhibit the maturational effect of
control on the lungs (RDS)
Gestational age Pathophysiology
Before 9 weeks Malformation
Before 20 weeks fetal islet cells are incapable of responding
hyperglycemia leading to IUGR.
After 20 weeks Fetus responds to hyperglycemia with
pancreatic beta cell hyperplasia and insulin
levels.
Seen in 3-10 % of pregnancies
In Kuwait incidence of Diabetes is high
23 % of population are diabetic-
35% type 1 and 65% type 2
Major congenital malformations are found in
5-9 % of affected infants
Affected Group Mortality Rates
Still birth and perinatal 5 times more than general
population
Neonates 15 times
Infants 3 times
Fetal macrosomia
Fetal congenital malformation
Impaired fetal growth
Pulmonary disease
Metabolic and electrolyte abnormalities
Haematological problems
Cardiovascular abnormalities
Congenital malformations
Large for gestational age
Birth weight more than 90th percentile or
above 4000 gm
More likely to have hyperbilirubinemia,
hypogycemia and acidosis
Birth injury, shoulder dystocia
Brachial plexus palsy and Subdural
haemorrhage
Facial palsy
Impaired Fetal growth (associated with ‘Too
tight control’ )
Maternal vascular disease
is the common cause of
impaired fetal growth
Increased number of Respiratory Distress
Syndrome
More incidence of TTN, PPHN and
pneumothorax
In contrast, Fetal lung maturation may occur
in diabetic pregnancies complicated by
vasculopathy
Blood glucose level less than 2.6 mmol/L
Caused by hyper insulinemia due to hyperplacia of Fetal pancreatic beta cells
Neonate develops hypoglycaemia - continuous supply of glucose is stopped after birth
Strict glycaemic control decreases but does not abolish the risk
Symptoms –• Jitteriness• Irritability • Poor feeding • Weak cry• Hypotonia• Seizure
Definition → total serum calcium < 1.8 mmol/L
or ionized calcium < 1 mmol/L
Caused by lower PTH level
Symptoms → jitteriness or seizures
Definition → serum magnesium concentration less than 0.75 mmol/L
Mechanism is increased urinary loss secondary to diabetes
Prematurity may be a contributing factor
Hypocalcaemia may not respond to treatment until the hypomagnesaemia is corrected.
65% of all IDMs demonstrate abnormalities of
iron metabolism at birth
Iron deficiency increases an infants risks for
neuro-developmental abnormalities
Haematocrit more than 65%
Plethoric appearance, sluggish capillary refill
or respiratory distress
Excess red blood cells precursors lead to
hyperbilirubinemia or thrombocytopenia.
Hypertrophic cardiomyopathy with intra ventricular hypertrophy may occur in 50% of IDM
Infants are often asymptomatic, but 5 to 10% have respiratory distress or sign of heart failure
Symptomatic infants typically recover after 2-3 weeks of supportive care
VSD
TGA
PDA
Caudal Regression Syndrome → structural defects of caudal region → 200 times more frequent
Severe form is known as Sirenomelia or Mermaid Syndrome
Risk of Spinabifida →20 times higher
Anencephaly → 13 times
Microcephaly, holoprosencephaly
Renal → hydronephrosis, renal agnesis,
ureteral duplication
GI → duodenal or anorectal atresia, Small
Left Colon Syndrome (presents as transient
inability to pass meconium, lower bowel
obstruction)
Unilateral micro-opthalmia
Bilateral Microtia
Cleft Palate
Micro Penis
Unilateral Cryptorchidism
Bilateral Radial Hypoplasia
Unilateral Polydactyly
Bifid Tongue
Single Umbilical Artery
Investigation
1. CBC
2. RBS
3. ABG
4. Calcium
5. Magnesium
6. Chest X-ray
7. Abdominal X-ray
8. Echo
9. Barium Enema
Intervention is required if:
1. plasma value < 36 mg/dL or 2 mmol/L
2. infant develop symptoms
3. glucose level does not increase after feeding
Target glucose level 45 mg/dL or 2.5 mmol/L
Profound hypoglycaemia requires IV therapy
with hydrocortisone
Immediate IV therapy with 2-4 ml/Kg in symptomatic infants
Maintain continuous infusion of 6-8 mg/Kg/min
If the follow-up glucose level remains low, dextrose infusion increase by 2 mg/kg/min
Maintain 80-100 ml/kg/day
If infant requires dextrose concentration more than 12.5% insert central line
Early breast feeding- colustrum as well as
breast milk provides generous concentration
of glucose
Monitor plasma glucose routinely
Adequate enteral feeding
Cardiologic screening
Excellent prognosis