Answer
1)Further history
-Whether the baby is term or not
-Apgar score of the baby after the delivery
-Presentation of the baby during delivery (cord, breech, cephalic)
-Any meconium stain liquor
-Mother’s blood group
-Prolong second stage of labour, difficult delivery, usage of instrumental delivery
-Mother blood group
-History of big baby in previous pregnancy and complication related to big baby.
-Ante natal history (any detail scan, glycemic control or any complication during pregnancy)
2)Complication of infant of diabetic mother
a)Congenital malformation (Congenital heart malformation, sacral agenesis, hypoplastic left colon)
b)Intrauterine growth restriction
c)Macrosomia and complication related to macrosomia (Shoulder dystocia, injured arm, cephalopelvic disproportion)
d)Respiratory distress syndrome
e)Polycythemia
f)Hypertrophic cardiomyopathy
g)Hypoglycaemia.
h)Intrapartum asphyxia
3)Hypoglycaemia in infant of diabetic mother
In infant of diabetic mother, the storage of glycogen in sufficient. However, since the baby is exposed to hyperglycemia in utero, therefore there will be pancreatic islet cell hyperplasia. This will result in hyperinsulinaemia. Once the baby is born and delay feeding, it will resulting in hypoglycemia.
4)Accepted targeted blood sugar level in infant is more than 2.6 mmol/L. However for practical purpose especially in infant of diabetic mother it should be more than 3 mmol/L. prolong symptomatic hypoglycemia may cause permanent neurological disability in the infant.
5)Respiratory distress syndrome in infant of diabetic mother
Elevated insulin level prior to birth inhibit action of cortisol for lung maturation (inhibit production of surfactant by type 2 pneumocytes.)
6)Management
a)Access the condition of the patient. If in respiratory distress, go with Advance Life Support algorithm.
b)Perform full physical examination to look for the complication of diabetes and birth.
c)Blood investigation
-Full blood count to look for polycythemia (significant if more than 65%)
-Close monitoring of capillary blood sugar level. random blood sugar level should also be taken.
-Blood urea and serum electrolyte to look for hypomagnesia, hypocalcaemia.
-Serum bilirubin (total, conjugated and non conjugated)
-Arterial blood gas in evidence of respiratory distress
d)Imaging studies
-Chest x ray for evidence of cardiomegally, ARDS, congenital pneumonia, great vessel abnormality
-Cardiac echocardiography to access myocardium thickness and anatomical malformation (VSD, TGA)
-Other part x ray based on suggestive finding (limb deformity)
e)If patient is hypoglycemia, give feeding if no contraindication. If not, give IV dextrose 10%.
f)Admit patient to NICU for further management and observation.
1)Further history
-Whether the baby is term or not
-Apgar score of the baby after the delivery
-Presentation of the baby during delivery (cord, breech, cephalic)
-Any meconium stain liquor
-Mother’s blood group
-Prolong second stage of labour, difficult delivery, usage of instrumental delivery
-Mother blood group
-History of big baby in previous pregnancy and complication related to big baby.
-Ante natal history (any detail scan, glycemic control or any complication during pregnancy)
2)Complication of infant of diabetic mother
a)Congenital malformation (Congenital heart malformation, sacral agenesis, hypoplastic left colon)
b)Intrauterine growth restriction
c)Macrosomia and complication related to macrosomia (Shoulder dystocia, injured arm, cephalopelvic disproportion)
d)Respiratory distress syndrome
e)Polycythemia
f)Hypertrophic cardiomyopathy
g)Hypoglycaemia.
h)Intrapartum asphyxia
3)Hypoglycaemia in infant of diabetic mother
In infant of diabetic mother, the storage of glycogen in sufficient. However, since the baby is exposed to hyperglycemia in utero, therefore there will be pancreatic islet cell hyperplasia. This will result in hyperinsulinaemia. Once the baby is born and delay feeding, it will resulting in hypoglycemia.
other pathophysiology of hypoglycemia in infant of diabetic mother
a)increased peripheral insulin receptors
b) reduced glucagon response to postnatal hypoglycemia
c) delayed evocation of hepatic gluconeogenic pathways
a)increased peripheral insulin receptors
b) reduced glucagon response to postnatal hypoglycemia
c) delayed evocation of hepatic gluconeogenic pathways
4)Accepted targeted blood sugar level in infant is more than 2.6 mmol/L. However for practical purpose especially in infant of diabetic mother it should be more than 3 mmol/L. prolong symptomatic hypoglycemia may cause permanent neurological disability in the infant.
5)Respiratory distress syndrome in infant of diabetic mother
Elevated insulin level prior to birth inhibit action of cortisol for lung maturation (inhibit production of surfactant by type 2 pneumocytes.)
other causes that can cause respiratory distress
a) polycythemia
b) hypoglycemia
c) congenital heart disease
6)Management
a)Access the condition of the patient. If in respiratory distress, go with Advance Life Support algorithm.
b)Perform full physical examination to look for the complication of diabetes and birth.
c)Blood investigation
-Full blood count to look for polycythemia (significant if more than 65%)
-Close monitoring of capillary blood sugar level. random blood sugar level should also be taken.
-Blood urea and serum electrolyte to look for hypomagnesia, hypocalcaemia.
-Serum bilirubin (total, conjugated and non conjugated)
-Arterial blood gas in evidence of respiratory distress
d)Imaging studies
-Chest x ray for evidence of cardiomegally, ARDS, congenital pneumonia, great vessel abnormality
-Cardiac echocardiography to access myocardium thickness and anatomical malformation (VSD, TGA)
-Other part x ray based on suggestive finding (limb deformity)
e)If patient is hypoglycemia, give feeding if no contraindication. If not, give IV dextrose 10%.
f)Admit patient to NICU for further management and observation.