Infant of the diabetic mother

 Pathophysiology:

poor control of diabetes leads to fetal hyperglycemia then hypertrophy of beta cells of the pancreas and hyperinsulinemia and increased hepatic glucose uptake, glycogen synthesis, lipogenesis, and protein synthesis leads to an increase in the weight of the placenta and fetal organs except for the brain.

*Macrosomia LGA.

*Myocardial hypertrophy.

*extramedullary hematopoiesis.

Separation of the placenta leads to interrupted glucose infusion, hyperinsulinemia, and hypoglycemia in 40% of cases this occurs 1-2 hours after delivery of blood glucose less than 35mg/dl. the baby suffered from lethargy, apnea, jitteriness, hypotonia, and poor feeding.

1-3% of gestational diabetic mothers.

0.5% of Insulin-dependent Diabetes Mellitus.

Clinical manifestations in the infant of the diabetic mother: 

*Hypocalcemia:

due to delay of parathyroid hormone rise or hypomagnesemia.

*Respiratory distress: due to 

# transient tachypnea of neonate (TTN).

#hpertrophic cardiomyopathy.

# Respiratory distress syndrome (RDS) due to decreased surfactant synthesis ( antagonist by insulin and cortisol).

# polycythemia.

# hypothermia.

*polycythemia and  hyperviscosity:

-An increase in insulin leads to an increase in erythropoietin formation.

-fetal hypoxia (placental insufficiency).

*hyperbilirubinemia:

indirect type is the most common but direct type may occur in duodenal atresia.

occur due to polycythemia, prematurity (decreased hepatic conjugation), and reduction in RBCs life spam

 (deformity due to glycosylation of membrane).

*Renal venous thrombosis:

due to polycythemia, DIC, and hypotension.  rare condition appears with hematuria and abdominal mass and

 diagnosed by U/S.

*Cardiomyopathy:

hypertrophic type due to the deposition of glycogen leads to congestive heart failure.


# cardiac (VSD,ASD,TGA).

#sacral agencies.

#GIT anomalies (small left colon syndrome ) appear as constipation and abdominal distension.

#duodenal atresia.

#renal anomalies (agenesis or hydronephrosis)

#CNS anomaly (anencephaly or meningocele).




Diagnosis:

frequent serum glucose levels.

measure calcium, magnesium, and ABG.

CBC

serum bilirubin

XRAY, ECHO, and ECG.


Management:

prophylactic measures.

good resuscitation and APGAR score.

correct blood glucose, magnesium, and calcium.

breastfeeding as early as you can.

warmth baby.

glucose 10% infusion.

manage cardiac insufficiency (contraindicated to use inotropic and digitalis ).


References:

Committee on Fetus and Newborn. Postnatal glucose homeostasis in Late-preterm and term infants.

Pediatrics. 2011;127:575-579. DOI:10.1542/peds.2010-3851.

Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report.Diabetes Care. 2002;25(S5).



















 









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