Infants of diabetic mothers
You are called to see a 9.5-pound newborn infant who is jittery. Physical
exam reveals a large plethoric infant who is tremulous. A murmur is heard.
Blood sugar is low.
Maternal hyperglycemia (types I and II DM) → fetal hyperinsulinemia
Insulin is the major fetal growth hormone → increase in size of all organs
except the brain
Major metabolic effect is at birth with sudden placental separation →
hypoglycemia
Infants may be large for gestational age and plethoric (ruddy).
Other metabolic findings: hypoglycemia and hypomagnesemia (felt to be a
result of delayed action of parathyroid hormone)
Common findings
Birth trauma (macrosomia)
Tachypnea (transient tachypnea, respiratory distress syndrome, cardiac
failure, hypoglycemia)
Cardiomegaly—asymmetric septal hypertrophy (insulin effect,
reversible)
Polycythemia (and hyperviscosity) → hyperbilirubinemia → jaundice
Renal vein thrombosis (flank mass, hematuria, and thrombocytopenia)
from polycythemia
Increased incidence of congenital anomalies
Cardiac—especially VSD, ASD, transposition
Small left colon syndrome (transient delay in development of left side
of colon; presents with abdominal distention)
Caudal regression syndrome: spectrum of structural neurologic defects
of the caudal region of spinal cord which may result in neurologic
impairment (hypo, aplasia of pelvis & LE)
Prognosis—Infants of diabetic mothers are more predisposed to diabetes and
LGA infants are at increased risk of childhood obesity.
Treatment
Monitor carefully and advocate good glucose control during pregnancy.
Follow glucose carefully in infant after delivery.
Early, frequent feeds: oral, NG if episodes of hypoglycemia continue
Intravenous dextrose infusion if above does not result in euglycemia