infant of diabetic mother

1. Infant of
diabetic
mother
Mai alshammari 161210115
Habiba jahin 161210099

2. TABLE OF CONTENTS
Case scenario
Clinical features
Introduction
Management
01
03
02
04
Prognosis
05

3. Case scenario
A newborn infant male delivered to a 25 year old G5P3, A+ mother at 37 weeks gestation by C section (for
non-reassuring fetal heart tones). The pregnancy is notable for an antenatal ultrasound diagnosis of cleft lip
and palate. Maternal serologies are unremarkable and her prenatal glucose tolerance test elevated.
At delivery, blow-by oxygen is given for about 2 minutes for poor color and respiratory effort. Apgar scores
are 6 (-2 color, -1 tone, -1 respiratory effort) and 9 (-1 color) at one and five minutes, respectively.
Exam: Vital signs are normal. Oxygen saturation is 99% in room air. Weight is 4100 gms, height is 54 cm
and head circumference is 37.5 cm (all >95th percentile for gestational age). The infant is active and jittery
with an obvious left sided cleft lip and palate. Heart is regular without murmurs. Lungs are clear. Abdomen
is soft, without masses or hepatosplenomegaly. The remainder of the initial exam is normal.
The infant is transferred to the term nursery for transitioning. A bedside glucose is obtained and the blood
sugar is read as close to 5 mg/dl.
What is the diagnosis?

4. Ddx?
Electrolyte abnormality: hypoglycaemia,
hypocalcaemia
Neonatal sepsis
Neonatal abstinence syndrome
Neurological disorders
Definite dx: hypoglycaemia

5. INTRODUCTION
Diabetes in pregnancy is associated with an increased risk of fetal, neonatal, and
long-term complications in the offspring.
Maternal diabetes may be pregestational (ie, type 1 or type 2 diabetes diagnosed
before pregnancy with a prevalence rate of about 1.8 percent) or gestational (ie,
diabetes diagnosed during pregnancy with a prevalence rate of about 7.5
percent).
The risk of complications varies depending on the gestational age (GA), birth
weight (BW), and the degree and severity of maternal hyperglycemia
Neonatal complications and congenital anomalies observed in diabetic
pregnancies contribute to a reported perinatal mortality rate that ranges from
0.6 to 4.8 percent. Strict glycemic control preconception and during pregnancy
is associated with lower perinatal mortality and morbidity.

10. 1. FETAL EFFECTS
a) In the first trimester and time of conception:
maternal hyperglycemia can cause diabetic embryopathy resulting in major
birth defects and spontaneous abortions. This primarily occurs in pregnancies
with pregestational diabetes.
Poor glycemic control in pregnant diabetic women leads to deleterious fetal effects
throughout pregnancy, as follows
b) In the second and third trimesters:
Diabetic fetopathy occurs resulting in fetal hyperglycemia, hyperinsulinemia, and
macrosomia.

11. 2. NEONATAL EFFECTS
Neonatal complications in offspring of diabetic mothers include:
- Congenital anomalies
- Prematurity
- Perinatal asphyxia
- Macrosomia, which increases the risk of birth injury (eg, brachial plexus injury)
- Respiratory distress
- Metabolic complications including hypoglycemia and hypocalcemia
- Hematologic complications including polycythemia and hyperviscosity
- Low iron stores
- Hyperbilirubinemia
- Cardiomyopathy

12. Congenital malformations
Includes: Transposition of the great arteries (TGA), double outlet right ventricle (DORV),
ventricular septal defect (VSD), truncus arteriosus, tricuspid atresia, and patent
ductus arteriosus (PDA)
1.cardiovascular system
2.central nervous system (CNS)
Anencephaly and spina bifida
3.GIT
intestinal anomalies; small left colon syndrome, cleft palate
4. Skeletal
caudal regression syndrome, Flexion contracture of the limbs, vertebral anomalies

13. Macrosomia
Result in higher chest-to-head and shoulder-to-
head ratio, higher body fat, and thicker upper
extremity skinfolds. they appear large and
plethoric, with excessive fat accumulation in the
abdominal and scapular regions, and have
visceromegaly
Macrosomia, defined as BW greater than the 90th percentile on a population-appropriate
growth chart or above 4000 g
Birth injury — Macrosomia predisposes to birth injury,
->>shoulder dystocia, brachial plexus injury, clavicular
or humeral fractures, perinatal asphyxia, and, less
often, cephalohematoma, subdural hemorrhage, or
facial palsy

14. Respiratory distress
Caused by Respiratory distress syndrome (RDS); due to surfactant deficiency and Tachypnea of the
newborn (TTN): RR >60 bpm, cyanosis and increased work of breathing, manifested by nasal
flaring, mild intercostal and subcostal retractions, and expiratory grunting
Metabolic complications
hypoglycemia: jittery, tremulous, and hyperexcitable during the 1st 3 days after birth, and hypotonia,
lethargy, and poor sucking, sweeting, Tachypnea. seizures may occur.
hypocalcemia; jittery and often have muscle jerking that is induced by environmental noise or other
stimuli. Generalized or focal clonic seizures may occur. Rarly; inspiratory stridor caused by laryngospasm,
wheezing caused by bronchospasm, or vomiting possibly resulting from pylorospasm
hypomagnesemia. usually is transient and asymptomatic
Polycythemia and hyperviscosity syndrome
Defined as a central venous hematocrit of more than 65 percent. Polycythemia may lead to hyperviscosity
syndrome, including vascular sludging, ischemia, and infarction of vital organs;e.g. renal vein thrombosis.
Low iron stores
Hyperbilirubinemia >> neonatal jaundice
Cardiomyopathy
->> risk for transient hypertrophic cardiomyopathy ; thickening of the interventricular septum (IVS) with
reduction in the size of the ventricular chambers, resulting in potential obstructed left ventricular outflow

15. NEONATAL MANAGEMENT
1.Prior to delivery
Immediately after delivery
Evaluation following
transition from the
delivery room
Assessment of the need for neonatal resuscitation is made based on the
GA, anticipated BW, presence of a congenital anomaly or labor
complications, and the mode of delivery (eg, cesarean delivery).

16. NEONATAL MANAGEMENT
Drying, clearing the airway of secretions, maintaining warmth, and a rapid
assessment of the infant's clinical status based on heart rate, respiratory effort, tone,
and an examination to identify any major congenital anomaly. If the infant does not
require additional resuscitation, the infant should be given to the mother for skin-to-
skin care and initiation of breastfeeding in the delivery room.
Prior to delivery
2.Immediately after
delivery
Evaluation following transition
from the delivery room

17. NEONATAL MANAGEMENT
Prior to delivery
Immediately after delivery
3.Evaluation following transition from
the delivery room
comprehensive examination, and laboratory screening for hypoglycemia and polycythemia.
- If cyanosis >assess for cardiac and respiratory disease including measurement of oxygen
saturation by pulse oximetry.
- The hematocrit should be measured within the first few hours of delivery.
- Bilirubin levels should be measured if the infant appears to be jaundiced
- Calcium and magnesium levels should be obtained in any infant with symptoms compatible
with either hypocalcemia or hypomagnesemia (eg, seizure or jitteriness).

18. NEONATAL MANAGEMENT
Prior to delivery
Immediately after delivery
3.Evaluation following transition from
the delivery room
- Glucose monitoring performed within one to two hours
after birth or whenever symptoms consistent with
hypoglycemia occur. Samples should be obtained
before feedings. Surveillance is performed for the first
12 to 24 hours of life. Monitoring is continued after 24
hours of life, in infants with low plasma glucose
concentrations (less than 45 mg/dL, 2.5 mmol/L) until
feedings are well established and glucose values have
normalized.
- Early feeding within 1 hr after birth to prevent the transient
hypoglycemia.
- if the plasma glucose is <40 mg/dL and clinical symptoms
of hypoglycemia are present?

19. LONG-TERM OUTCOME
Increase Risk of
Diabetes
Increased BMI and
impaired glucose
metabolism
poorly controlled maternal diabetes
during pregnancy may negatively
impact neurodevelopmental outcome

20. Do you have any questions?
THANKS

21. References