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Infant Of Diabetic Mother

Infant Of Diabetic Mother. By: Dr.Kishwar Bloach. Definition . “ Condition or a set of complications in the baby when adequate control of diabetes mellitus has not been accomplished in the mother during pregnancy”. Incidence. Insulin dependent diabetes occurs in 0.5 % of all pregnancies.

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Infant Of Diabetic Mother

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  1. Infant Of Diabetic Mother By: Dr.Kishwar Bloach

  2. Definition “Condition or a set of complications in the baby when adequate control of diabetes mellitus has not been accomplished in the mother during pregnancy”

  3. Incidence • Insulin dependent diabetes occurs in 0.5 % of all pregnancies. • 1% – 3% women have gestational diabetes.

  4. Pathophysiology Maternal hyperglycemia Fetal Hyperglycemia Fetal Pancreatic response Fetal Hyperinsulinemia Both above cause Increase Hepatic glucose uptake Glycogen Synthesis Accelerated Lipogenesis Protein Synthesis

  5. Separation of placenta at birth Interrupt glucose infusion into neonate No effect on Hyperinsulinism Leading to Hypoglycemia Contributory factors Diminished response to epinephrine Diminished response to Glucagon

  6. Congenital Anomalies Hyperglycemia induced teratogenesis

  7. Clinical Manifestations • Macrosomia • Low birth weight if associated with maternal vascular disease • Hypoglycemia • Jumpy, tremulous & hyper excitable • Hypotonic, lethargy & poor sucking • Hypocalcaemia • Hypomagnesmia • Birth asphyxia • Tachypnea • Cadiomegaly & Heart Failure • Neurologic development & Ossification centers tend to immature • Congenital anomalies

  8. Complications • Macrosomia • SGA • Hypoglycemia in 40% • Hypomagnesmia • Birth Asphyxia in 25 % • Birth Trauma • Klumpke 0r Erb paralysis • Clavicle fracture • Cephalhematoma • RDS in 3% • Hypertrophic Cardiomyopathy in 50% • Hyperbilirubinemia • Polycythemia • Renal Vein Thrombosis • Congenital malformations in 6.4% • Cardiac malformations • Lumbosacral agenesis • Neural tube defects • Hydronephrosis • Renal agenesis • Duodenal atersia • Situs Inversus • Double Ureter • Holoprosencephaly • Small left colon syndrome

  9. Investigations • Serum Glucose • 0,0.5, 1, 1.5, 2, 4, 8, 12, 24, 36, 48 hr of age • Serum Calcium • 6, 24, 48 hr of age • Hematocrit • 0, 4, 24 hr of age • Serum Billirubin level • ABG’s • CBC • Radiological studies • ECG • Echo

  10. Management • Prenatal Evaluations • Fetal maturity • Biophysical profile • Doppler velocimetry • Plan delivery • Treat gestational diabetes • Infant Blood glucose & Hematocrit obtained • Observed for • Jitteriness • Tremors • Convulsions • Apnea • Weak Cry • Poor sucking

  11. Physical Examination for • Heart • Kidneys • Lungs • Extremities • Frequent feeding • Treat Hypocalcaemia • Treat Hypoglycemia • Bolus Inj. 10% D/W 2ml/kg • Infusion of 10% D/W rate 6 to 8 mg/kg/min and may increase up to 12 mg/kg/min • Serum glucose followed every 30 to 60 mins • Highest Concentration of glucose can be infused through a peripheral line is 12.5 % • Give Steroids Inj. Glucocorticoides • Glucagon • Treat complications

  12. Prognosis • Morbidity and mortality decrease with adequate control of diabetes • Physical development normal but oversized infants predisposed to obesity

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