407 newborns with idiopathic transitory hyperbilirubinaemia were examined with regard to the decrease in serum bilirubin levels during 24 hours of intermittent phototherapy (12 hours of light exposure). The photoeffect (i.e. decrease of serum bilirubin concentration after 24 hours of therapy) showed a unique and predictable nonlinear correlation with the plasma bilirubin concentration before treatment. This relationship can be used for individualizing the duration of phototherapy and the dose of light. The apparent effect of birth weight, gestational age, and postnatal age on the efficiency of phototreatment is only due to differing initial levels of bilirubin concentration. Intermittent illumination seemed to be more efficient than continuous.

The purpose of this retrospective study was to determine the risk factors for the morbidity of the mothers and their fetus in patients with diabetic retinopathy and/or nephropathy with an open family planning. We compared the course of pregnancies, complications as well as the maternal and neonatal morbidity in 76 patients with diabetic retinopathy or nephropathy (White R F) with 85 patients without severe microangiopathy (White C D). We found a correlation between retinopathy progression and hyperglycaemia during the first trimester (p < 0.05). There was an increase in the deterioration of visual acuity up to blindness due to the progression of this microangiopathy in cases of proliferative retinopathy. There was a significant increase of the mean diastolic blood pressure (mdp) and preeclamptic symptoms occurred in 71% of the cases with severe microangiopathy (p < 0.05). Deterioration of the diabetic nephropathy with excessive proteinuria (> 10 g/d) and unmanageable hypertension or a progression of the retinopathy led to an earlier delivery in 80% of the patients (p < 0.05). A high rate of preterm deliveries (39%) and a frequent occurrence of intrauterine growth retardation's (9%) characterised the fetal outcome. The following examinations for a patient with an open family planning, if diabetes is diagnosed during childhood or the course of the disease is between 10 and 15 years, should be done: Ophthalmological evaluation, control of the renal function, contraceptive advice and an improvement of the metabolic situation. In case of a diabetic nephropathy in combination with hypertonus the patients shoud be warned against pregnancy.(ABSTRACT TRUNCATED AT 250 WORDS)

and the 'Gerhard Katsch' Central Research Institute for Diabetes, Karlsburg, G.D.R.). Neonatal jaundice in infants of diabetic mothers. Acta Paediatr Scand Suppl360: 101, 1989. 357 IDMs and 20 healthy newborns of non-diabetic mothers were examined at term for body measurements, red blood cell count, serum bilirubin, cord blood insulin and blood glucose during the first postnatal week. The stage of maternal diabetes did not influence the course of neonatal bilirubin levels, but the IDMs had prolonged and higher bilirubinaemia compared with the controls. Hyperbilirubinaemia was found to be most prominent in newborns with an increased birthweightllength ratio and was not simply related to macrosomia (LGA). These infants had significantly lower blood glucose concentrations immediately after birth, whereas cord blood insulin was found to be identical between the I D M sub-groups. Bilirubinaemia in heavy for length infants was slightly correlated to haematocrit. For the pathogenesis of hyperbilirubinaemia in IDMs induction of heme oxygenase (due to a lack of energy provision following a phosphorylation disorder) is discussed. Nutritional support (early feeding, glucose infusions) does not affect the course of bilirubinaemia. Key words: infants of diabetic mothers, bilirubin metabolism, hyperbilirubinaemia.In spite of remarkably reduced mortality and lower malformation rates in infants of diabetic mothers (IDMs), due to modern strategies in the management of diabetes during pregnancy, the incidence of macrosomia and hyperbilirubinaemia in these newborns has remained relatively high.Opinions concerning the pathogenesis of these phenomena differ to some extent (1-3), but most of them are based on the classical theory of Pedersen (4): maternal hyperglycaemia leads to fetal hyperglycaemia and subsequently to hyperplasia of the fetal pancreatic islets. This basic disorder is thought to be responsible for most of the clinical signs and symptoms which can be observed in IDMs, including hyperbilirubinaemia.But, since the IDMs form a heterogeneous group we speculated that the problem of hyperbilirubinaemia was not identical for all of them. Therefore, the aim of our study was to look for different types of IDMs with reference to their somatic development and metabolic condition and the degree of hyperbilirubinaemia in the first week after birth. MATERIALS AND METHODSFrom January 1984 until December 1987 a total of 382 diabetic women gave birth in the Obstetric Department of the Karlsburg Central Institute. The main principles of management were: ( a ) insulin treatment to keep blood sugar in or near the normal range (if possible already praeconceptionally); (b) hospitalization of pregnant women in the 32nd week of gestation for early treatment of complications related to pregnancy as well as to diabetes; (c) delivery near

Acidosis is known as a risk factor for the development of bilirubin encephalopathy in neonatal jaundice. However, few attempts have been made to evaluate the influence of acid-base state on bilirubin-albumin binding state in blood of newborn infants. Therefore, in 171 appropriate and 83 small for gestational age newborns (birthweight less than 2,500 g) the acid-base state in blood and bilirubin (BR) binding state in serum was measured at the ages of 3, 4, 5, and 8 days. There is a weak but significant correlation between standard base deficit and the ratio BR/reserve albumin as well as the toxic potential of serum BR. The results suggest that the higher risk in acidosis is not only caused by increased tissue binding of BR but also--at least partially--attributable to decreased BR binding in serum.

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