INFANTS OF DIABETIC MOTHERS

Clinical Features

Size at birth will depend on the degree of diabetic control in the mother as well as the stage of foetal development. Hence the baby may be large, appropriate, or small for gestation.

Complications

These include:

  • Perinatal asphyxia and injury,
  • Hypoglycemia (most likely in babies who are either large or small for their gestation age),
  • Hypocalcaemia,
  • Hyperbilirubinaemia,
  • Respiratory distress syndrome (RDS),
  • Polycythaemia, and
  • Feeding problems.

Investigations

  • Blood sugar
  • Bilirubin if indicated
  • Haemoglobin or haematocrit if plethoric
  • Others as indicated

General Management

Diabetic mothers should deliver in hospital, where problems of the baby can be dealt with. Appropriate management of such mothers include:

  • Close cooperation between obstetrician and paediatrician.
  • Maintenance of normoglycaemia in the mother [see diabetes in pregnancy].
  • Decision on timing of delivery is made in consultation with the obstetrician.
  • During delivery:
    • Manage as for routine care of all babies.
    • Obtain cord sample for blood sugar.
  • In nursery:
    • Feed within an hour of delivery and then 3-hourly.
    • Monitor blood sugar at admission and then 3-hourly for 24 hours.
  • Treat hypoglycaemia:
    • If blood glucose remains low (blood sugar <2.2mmol/L) despite feeding, establish an IV line and give 2ml/kg of 10% dextrose over 5 minutes and continue with 10% dextrose at the volume requirement per day. Repeat
      blood glucose after 30 minutes. If stabilized, then measure sugar 3-hourly. When the baby’s blood glucose is normal on 2 more readings, gradually reduce the infusion as you increase the feeds.
  • Treat hypoglycaemia: Calcium levels should be determined at 6, 12, 24, and 48 hours if possible.
    • If hypocalcaemic (serum calcium <7mg/dl), give 3 ml/kg of 10% calcium gluconate IV slowly.
  • Treat anaemia: Estimate haematocrit at 1 and 24 hours.
    • If haematocrit >65% do partial exchange transfusion 10–20ml of fresh plasma/kg.
  • Treat hyperbilirubinaemia: Estimate serum bilirubin levels at 24 and 48 hours.
    • If bilirubin elevated, treat as needed (see Section 26.12, Neonatal Jaundice).
  • Refer if congenital malformation(s) is/are present.