fozia presentation

8/11/2019 FOZIA Presentation

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Infant of the Diabetic Mother

Fozia Iqbal

House Officer

NICU, PIMS.


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Gestational Diabetes Mellitus

Any degree of glucose intolerance withonset or first recognition during

pregnancy


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Epidemiology

Women with GDM have 35-60% chance of developing diabetes mellitus over 10-20 yrs. later

3-10% hyperglycemic

80-85% GDM

35%

DM1

65%

DM2


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Risk factors for developing GDM

Obesity

Age GDM in previous pregnancies

Family history

Bad obstretical history


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Morbidities in Infants of Diabetic Mothers

Macrosomia

Hypoglycemia

RDS

IUGR

Hypocalcaemia

Hyperbilirubinemia

Congenital Anomalies

Polycythemia

Hyper viscosity

Cardiomyopathy

Increased fetal death

Postnatal problems


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Mechanisms of fetal morbiditiesMaternal Diabetes

Maternal Hyperglycemia

CongenitalMalformations

FetalHyperglycemia

Fetal hyper insulinemia

MacrosomiaRDS Neonatal hypoglycemia


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IDM - Outcome

Outcome is largely dependent onconsistent blood glucose controlfrom thepreconception period through embryonicand fetal life.

Lack of control in early or latepregnancyleads to different problems in theoffspring


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Hypoglycemia

Symptoms

Jitteriness 81%

Seizures 58%

Apnea/cyanosis 47%

Irritability 41 %

Hypotonia 26% Poor feeding

Hypothermia

None

Defintition: Blood glucose


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Hypoglycemia

Treatment

If stable give early feedings

If not able to feed:

D10%W 2mL/kg (slow IVP) plus

Continuous IV infusion of D10%W

at 80-100 mL/kg/day

Use glucagon in extreme cases

Follow blood glucose with

frequent Chemstrips


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Respiratory Distress

Transient Tachypnea of Newborn(delayed lungfluid clearance)

Aspiration of meconium or amniotic fluid

Prematurity

Diagnosis Tachypnea/Retractions

Grunting

Cyanosis

Apnea

Hypoxemia

Chest X-Ray


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Respiratory Distress Syndrome

Treatment:

Surfactant

Assisted support and ventilation

Supplemental oxygen


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Hyperbilirubinemia

Definitions: Elevated indirect(unconjugated) bilirubin >10mg/dL in

term infant, lower levels for preterms

Incidence in IDM 20-40%
http://www.cfnews13.com/uploadedImages/Stories/Health/Your_Health/0027.jpg


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Hyperbilirubinemia

Diagnosis Transcutaneous or serum bilirubin

at 24 hours of age, and at signs ofincreasing jaundice

Treatment:

Adequate hydration and nutrition

Phototherapy

Exchange transfusion

Medications

Family teaching

Appropriate follow-up afterdischarge


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Follow up for the IDM

Developmental risk:

CP , seizures 3-5 X common. SGA IDM infants

have increased risk for cognitive delay at 3-5

years.

Metabolic Risk:

IDMs with 1 parent Type DM have 1-6 % risk

of DM themselves


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NICU PIMS Statistics

January-March 2014


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Total MCH GDM Deliveries

SVD

C-sec

C-Sec 4%

SVD 11%

Total MCHdeliveries: 15


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Weight breakdown NICU

0

0.5

1

1.5

2

2.5

3

3.5


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Gestational Breakdown in NICU

0

0.2

0.4

0.6

0.8

1

1.21.4

1.6

1.8

2

37 weeks

expired

discharged


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NICU EXPIRIES


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NICU Discharge


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fozia presentation

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