Neonatal Jaundice in Infants of Diabetic Mothers

Abstract

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

Asymmetric Large-for-Gestational-Age Infants of Type 1 Diabetic Women: Morbidity and Abdominal Growth

“…The asymmetric LGA infants experienced a higher frequency of severe hypoglycemia (blood glucose < 20 mg/dL) and hyperbilirubinemia, reflecting persistently elevated fetal insulin levels after delivery and increased hemolysis and delayed clearance of bilirubin. These findings are consistent with those of Ballard et al and Jährig et al 5,6 The increased risk of complications associated with asymmetric LGA infants emphasizes the need to identify these infants in utero. The asymmetric LGA growth pattern is predominantly found in offspring of diabetic mothers.…”

“…nemia, and acidosis than symmetric LGA (birth weight proportionate to length) infants. 5,6 Therefore, early recognition of fetuses at risk for being asymmetric LGA at birth gives the caregiver a chance to optimize management of these newborns at increased risk for morbidity and mortality.…”

Phototherapy is commonly used for neonatal jaundice but greater control is needed to avoid toxicity in the most vulnerable infants

“…Peevy et al described an increased incidence of neonatal jaundice in LGA, but not AGA, infants who were born to diabetic mothers . Jährig et al found increased neonatal jaundice in AGA and LGA infants born to diabetic mothers, but noted that it was more pronounced in LGA infants . On the other hand, Gyurkovits et al studied nondiabetic macrosomic infants with birthweights of at least 4000 g and found that the incidence of neonatal jaundice was significantly lower in those infants than in the control group, where the birthweights ranged from 2500 to 3999 g. .…”

Clinical and metabolic profile of neonates of diabetic mothers

“…5 The major morbidities associated with infants of diabetic mothers include congenital malformations, macrosomia, respiratory distress syndrome, growth restriction, polycythemia, hypoglycemia, hypocalcemia, hypomagnesemia 11,12 & hyperbilirubinemia. 13 Other morbidities include myocardial dysfunction (in form of transient hypertrophic subaortic stenosis), renal vein thrombosis, and small left colon syndrome. 14 Successful management of infants of diabetic mothers is based on prevention or early recognition combined with treatment of these complications.…”