If the mother has no adequate control of diabetes mellitus during her pregnancy, it will lead to a set of complications in the newborn.

A diabetic female should move toward her reproductive life with a very well-planned pregnancy. She should hold a good control on her diabetes before she conceive, otherwise the newborn will face all the consequences.

http://medicrux.com/wp-content/uploads/2019/08/images6.jpg

PATHOPHYSIOLOGY:

  • Maternal hyperglycemia causes fetal hyperglycemia, which will further lead to fetal hyperinsulinemia (increased insulin in blood).
  • Fetal hyperinsulinemia then causes increased hepatic glucose uptake, glycogen synthesis and exceed protein synthesis.
  • While during delivery, the sudden separation of the placenta interrupts glucose infusion into the neonate. The condition leads to hypoglycemia during the first few hours after birth.

CLINICAL FINDINGS:

  1. Infant may be hyperexcitable and tremulous during the first few days after birth, plus hypotonia, lethargy and poor sucking also occurs. These are typical signs of hypoglycemia if signs appear earlier, while late appearance related to hypocalcemia.
  2. MACROSOMIA: Large and plump baby as a result of increased body fats, and enlarged visceras.
  3. Respiratory distress signs
  4. Chest X-ray shows an enlarged cardiac shadow indicates cardiac abnormality.
  5. Gross congenital malformations noted on physical examination.

COMPLICATIONS:

  • Hypoglycemia
  • Hypocalcemia
  • Hypomagnesemia
  • Macrosomia (large and plump baby)
  • Birth asphyxia: caused by prematurity, cesarean delivery, maternal vascular diseases, or macrosomia.
  • Birth trauma i.e clavicle fracture, cephalhematoma
  • Respiratory distress syndrome: As fetal hyperinsulinism adversely affect the lung maturation process. Delayed maturation of the lung surfactant production.
  • Increased fat and glycogen deposition in the myocardium lead to hypertrophic cardiomyopathy.
  • Increased bilirubin level
  • Polycythemia
  • Hyperviscosity
  • Congenital malformations: TGA (transposition of great arteries), ventricular septal defects, agenesis, situs inversus, anencephaly, meningocele syndrome, caudal regression syndrome etc.

http://medicrux.com/wp-content/uploads/2019/08/complic.jpg

LAB INVESTIGATIONS:

  • Serum glucose and serum calcium level after delivery.
  • Hematocrit should be checked at birth and after 24 hours.
  • Serum bilirubin level
  • ABG (arterial blood gas)
  • Complete blood count
  • Cultures and gram stain
  • Radiological studies for checking respiratory, cardiac, or skeletal problems.
  • ECG for hypertrophic cardiomyopathy.

MANAGEMENT:

In nursery, obtain blood for glucose and calcium level and hematocrit. The infant should be observed for any abnormal movements like convulsions, tremors, jitteriness, weak cry and poor sucking. Examine the infant physically to rule out any abnormality in heart, lung, kidney and limbs. Manage the hypoglycemia by glucose infusion, plus manage the other complications accordingly. Start feeding when baby is stable and able to suck.

 

Leave a Reply

Your email address will not be published. Required fields are marked *

Name *
Email *
Website