B/O Farhana, male baby was born by LUCS at 38 wks of gestation.

The mother was suffering from GDM since 26 wks of gestation and was on regular antenatal check up. The baby was large, plethoric without any respiratory distress or apparent congenital anomaly. His HR 140 / min, RR - 40 / min, temp - 99F with good primitive reflexes, birth weight - 4.2 kg, length - 54 cm and OFC - 35 cm.

Capillary blood glucose level recorded at 1st hour of age was 2.2 mmol/L, 2.4 mmol/L at 3rd hour and 2.9 mmol/L at 5th hour.

What is the Provisional Diagnosis

???

Infant Of Diabetic Mother

Welcome to Seminar on Infant Of Diabetic Mother

Definition:
Infant of Diabetic mother is a baby born to a mother who has diabetes.

Types of Diabetes in Pregnancy

Gestational DM Pre existing DM

Pathophysiology of GDM
Hormones produced by placenta like estrogen, progesterone, cortisol & human placental lactogen Contra insulin effect Additional insulin requirement to overcome the effect

Inadequate insulin production GDM

Additional insulin produced by pancreatic cells Normal pregnancy

Physiology of Glucose Control in IDM

Maternal hyperglycemia

Glucose & amino acid, but not insulin traverse placental membrane Increased blood sugar in fetus Fetal pancreatic cell hyperplasia

Increased insulin & pro insulin level

Physiology of Glucose Control in IDM (continued) Increased insulin & pro insulin level
Glycogen deposition protein synthesis fat deposition

hepatic glucose production

Inhibits fetal lung maturational effect of cortisol

Macrosomia Birth injury

Hypoglycemia

RDS

How to diagnose?

History: H/O diabetes or GDM in mother. Poor glucose control during pregnancy. Mother may have previous LGA infant. Antenatal records: RBS > 11.8 mmol/L USG in last trimester: LGA baby

Clinical Feature

Large baby. Poor feeding, lethargy and weak cry. Convulsion. Respiratory distress. Plethoric with puffy face. Jaundice. Tachycardia, tachypnea (in HF). Hepatomegaly. Cardiomegaly.

Problems associated with IDM

During birth:

Still born Neonatal death Premature labour Perinatal asphyxia Birth injury Shoulder dystocia Fracture of clavicle and humerus Brachial plexus injury

Problems associated with IDM (continued)

After birth:

LGA SGA Hypoglycemia Hypocalcaemia Hypomagnesaemia Respiratory Distress Syndrome Transient Tachypnea of Newborn Polycythemia Hyperbilirubinaemia

Problems associated with IDM (continued)

Congenital malformations: Cardiac Hypertrophic cardiomyopathy, VSD, TGA, ASD. Lumbosacral agenesis Renal agenesis. GIT - small left colon syndrome. Nervous system anencephaly, meningocele. Skeletal hemivertebrae, caudal regression syndrome.

Problems associated with IDM (continued)

Long term complications:

Obesity HTN DM Neurodevelopmental deficit

Investigations

S Glucose level: At delivery, 2 , 4, 6, 8, 12, 18, 24, 36, 48, 60, 72 hours of age. S Calcium level: At 6 , 24 , 48 hrs of age. S Magnesium level: Done if hypocalcemia present. Haematocrit. S Bilirubin.

Investigations (continued)

CBC, Hb%, Blood grouping ABG Radiological studies: CXR P/A view X - ray of involved joints associated with birth injury or congenital anomalies.

Echocardiogram
Barium enema

Treatment
Frequent

prenatal evaluation of mothers at

risk. Fetal evaluation Delivery planning Periconceptual glucose control Control during labor

Hypoglycemia
Asymptomatic:

Blood glucose levels : within 1st hr, then hourly for 6-8 hrs. If normoglycemic start feeding ( oral or NG) If feeding unsuccessful: IV glucose 4-8 mg/kg/min Hypertonic glucose should be avoided.

 Symptomatic:

IV bolus of 2cc/kg of DW 10%, if seizures 4cc/kg to be given. IV infusion at rate of 8mg/kg/min If inadequate concentration can go up to 20% .

 Hydrocortisone:

5mg/kg/day

Glucagon
Diazoxide Octreotide Measure

glucose hourly then Q 4-6 hrs Never abruptly stop IV glucose infusion: reactive hypoglycemia

 Hypoglycemia

usually resolves within 24

hrs Persistent hypoglycemia : persistent hyperinsulinemia If more than 7 days consider other causes.

thank you!

Maui Sunset