case• A Male baby UA @ 36+5weeks gestational

age delivered on 10-9-2011 through Elective LSCS under s/a due to prev.2 c.sections.

• Baby cried spontaneously after birth

• Apgar score at 1min. 5/10 and 5 min.8/10

ANTENATAL HISTORYBooked patient:

Mother age: 35 year

Mother's blood group B +ve

Gestational age of baby 36+5 weeks

G3 P2 A0

Cousin marriage

No h/o HTN,D.M.,HEPATITIS or any other illness to mother found.

h/o G.D.M. & insulin R_16M,16E

2 other siblings (1 male,1 female) are alive & healthy.

GENERAL PHYSICAL EXAMINATION

Birth wt. 3.1 kg

Heart rate 164/min.

RR 68/min.

G.Appearance: p.cyanosis

Eyes Normal

Femoral pulses b/l palpable

Fontanel normal (open)

RESPIRATORY SYSTEM

NVB

b/l equal chest movements

On Auscultation:

b/l equal air entry

b/l clear chest

CARDIO VASCULAR SYSTEM

• S1 + s2 + 0

GIT

Soft abdomen

Non distended

No visceromegaly

BS +Ve

CENTRAL NERVOUS SYSTEM

• Neonatal reflexes present

• Moro +ve

• Grasping +ve

• Sucking +ve

EXTERNAL GENITALIAGrossly normal penis & urethra

B/l descendent testes

Anus Patent

BSR after Birth

38 mg/dl

DIFFERENTIAL DIAGNOSIS

Infant of diabetic Mother

Hypoglycemia

Baby admitted to NICU:

• Kept on Warmer

• Temperature maintained

• Baseline investigation sent

• Oral feed trial

• BSR monitoring 1 hrly

• Hb 15.5mg/dl

• Tlc 11900

• RBC 5.12

• Plt 356000

• Mcv 99

• Mch 3o

• Mchc 31

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INVESTIGATIONS:• DLC:

• Polymorphs 44%

• Lymphocytes 48%

• Monocytes 04%

• Eosinophils 04%

• S Calcium 9.5mg/dl

• Blood sugar random 18mg/dl

• Baby's blood group A+ve

X Ray Chest

Normal

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1 hr BSR MONITORING

10/09/11

4.oo p.m 36 mg/dl

5.oo p.m 52 mg/dl

6.oo p.m 74 mg/dl

7.oo p.m 96 mg/dl

8.oo p.m 83 mg/dl

9.oo p.m 56 mg/dl

1o.oo p.m 72 mg/dl

11.oo p.m 46 mg/dl

oo.oo a.m 84 mg/dl 16

11/09/11

2.oo a.m 110 mg/dl

4.oo a.m 55 mg/dl

o6.oo a.m 63 mg/dl

o8.oo a.m 47 mg/dl

o9.oo a.m 57 mg/dl

inj.solucortef i/v 8hrly started

1o.oo a.m 60 mg/dl

12.oo p.m 78 mg/dl

o4.oo p.m 70 mg/dl

o8.oo p.m 92 mg/dl17

oo.00 a.m 96 mg/dl

12/09/11

04.Oo a.m 92 mg/dl

O8.oo a.m 88 mg/dl

Monitoring stopped

Discharged …………..

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DIAGNOSIS

• Infant Of Diabetic Mother

What is IDM

Infant of a diabetic mother is a BABY born to a mother who has Diabetes.

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Types of diabetes in pregnancy

• Gestational diabetes

• Pre existing diabetes

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Physiology of glucose control in IDM Maternal hyperglycemia

Glucose, amino acid but not insulin

traverse placental membrane

Increased blood sugar in Fetus

Fetal pancreatic b cell hyperplasia

Increased insulin & pro insulin level22

• Continued……… Increased insulin & pro insulin level

Glycogen deposition inhibits fetal lung

protein synthesis maturational effect of

fat deposition cortisol

hepatic glucose

production

Macrosomia Hypoglycemia

RDS

Birth injury

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How to diagnose???• History >

• h/o diabetes or Gdm in mother

• poor glucose control during pregnancy

• mother may have previous LGA infant

• Antenatal records>

• USG in last trimester_LGA baby

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Clinical features• Large baby

• Weak cry

• Lethargy, poor feeding

• Jaundice

• Plethoric with puffy face

• Blue or mottled skin color,

• Tachycardia,tachypnoe,respiratory distress

• Tremors shortly after birth

• Convulsions

• Hepatomegaly,cardiomegaly 25

Problems associated with IDM• During birth

• Macrosomia

• Prenatal asphyxia

• Preterm labour

• Birth injury

• shoulder distocia,brachial plexus injury,

fracture of clavicle or humerus.

• Still born

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• After birth problems associated with IDM

• LGA (contd.)

• SGA

• Hypoglycemia

• Hypocalcemia

• Hypomagnesaemia

• Respiratory distress syndrome

• Transient tachypnoe of new born

• Hyperbulirubinemea,hyperviscosity syndrome• Congenital malformations

vsd,asd,tga,anencephaly,meningocele,caudal regression syndrome, renal agenesis.

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• Long term Complications

• Obesity

• HTN

• DM

• Neurodevelopment deficit

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Investigations• s/glucose level at delivery,2,4,6,8,12,18,24,36,48,60,72 hrs of age.

• s/calcium level at 6,24,48 hrs of age

• s/magnesium level done if Hypocalcemia

• Hematocrit at birth 4 & 24 hrs of age

• s/bilirubin

• CBC,BBG29

• Chest x ray,x ray of joints in case of birth injury

• Echocardiogram

• Barium enema to rule out congenital anomalies

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Management • Continuing evaluation bsr monitoring, signs of hapocalcemea,jaundice,cvs

disorders,rds,in 24 hrs

• Hypoglycemia 10% d/w infusion

If persistent hypoglycemia consider a trial of corticosteroids

& obtain endocrinology consultation

• Hypocalcemia with calcium gluconate

Hypomagnesaemia with mgso4

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• Management of other problems

• Treat accordingly

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Prognosis • Less morbidity & mortality with adequate control.

• Evidence suggests an increased incidence of obesity & metabolic syndrome during childhood.

• If diabetes is poorly controlled during pregnancy, a high risk of neurodevelopmental deficit is reported as child grows.

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Thank you