Abstract 16893: Subclinical Decrease in Myocardial Function in Asymptomatic Infants of Diabetic Mothers: A Tissue Doppler Study

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Jenny E Zablah ◽  
Dorota Gruber ◽  
Denise A Hayes
Keyword(s):  
Birth Weight ◽  
Cardiac Hypertrophy ◽  
Gestational Age ◽  
Myocardial Function ◽  
Ductus Arteriosus ◽  
Tissue Doppler ◽  
Doppler Imaging ◽  
Infants Of Diabetic Mothers ◽  
Ultrasound System ◽  
Diabetic Mothers

Introduction: Infants of diabetic mothers (IDMs) with cardiac hypertrophy are recognized to have impaired myocardial performance, but less is known about ventricular function in those without hypertrophy. We hypothesized that, in asymptomatic newborns with normal echocardiograms, tissue Doppler imaging (TDI) indices of cardiac function would be decreased in IDMs compared to controls. Methods: This retrospective case-control study involved IDMs ≥ 36 weeks gestational age, at 0 to 7 days of life. Subjects with cardiorespiratory symptoms, ventricular hypertrophy or dysfunction, or any echocardiographic abnormality (other than a patent ductus arteriosus before 4 days of life, or a patent foramen ovale) were excluded. Each subject was matched with 3 controls (healthy infants of non-diabetic mothers) by age (0-24, 25-48, 49-72, or > 72 hours of life), birth weight (± 0.5 kg), body surface area (± 0.03 m 2 ), and by the ultrasound system utilized. TDI systolic (S’), early diastolic (E’), and late diastolic (A’) velocities were measured at the mitral valve (MV) annulus, basal ventricular septum, and tricuspid valve (TV) annulus, and were averaged from 3 consecutive cardiac cycles. Early Doppler inflow velocity to E’ ratios (E/E’) were calculated. Results: Seventy cases (39 male) were identified: first 24 hours (h) of life (n=18), 25-48 h (n=22), 49-72 h (n=14), and > 72 h (n=16). Maternal diabetes was gestational in 60 cases, and pre-existing in 10. Median gestational age was 38 6/7 weeks (range 36-41 2/7), median birth weight 3.65 kg (2.56-5.38), and median BSA 0.22 m 2 (0.17-0.27). Ultrasound system vendors included Siemens ® (n=46), Philips ® (n=23), and General Electric ® (n=1). Cases were matched with 210 controls. IDMs had significantly lower S’ ( p ≤ 0.05) and E’ ( p ≤ 0.01) velocities, and significantly higher E/E’ ratios ( p ≤ 0.01) at the MV, basal septum, and TV compared to controls (Wilcoxon rank-sum test). There were no significant differences in A’ values between groups. Intraclass correlation demonstrated 84-99% interobserver and 98-99% intraobserver reliability. Conclusions: In asymptomatic newborn IDMs without cardiac hypertrophy, TDI suggests a subclinical decrease in systolic and diastolic myocardial function compared to controls.

scholarly journals Assessment of Subtle Myocardial Dysfunction in Asymptomatic Infants of Diabetic Mothers

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
A A Kotby ◽  
W M Elguindy ◽  
N M S Soliman ◽  
S A Aboelmaati
Keyword(s):  
Myocardial Function ◽  
Heart Diseases ◽  
Myocardial Dysfunction ◽  
Tissue Doppler ◽  
Doppler Imaging ◽  
Cross Sectional ◽  
Infants Of Diabetic Mothers ◽  
Cardiac Functions ◽  
Hospital Pediatric ◽  
Diabetic Mothers

Abstract Background Cardiovascular abnormalities in infants of diabetic mothers (IDMS) occur in the form of congenital heart diseases (CHD), and hypertrophic cardiomyopathy (HCM). Aim of the Work We hypothesized that two dimensional speckle tracking imaging and pulsed wave tissue Doppler imaging (TM) may uncover subtle myocardial dysfunction in asymptomatic IDMs. Patients and Methods This study was a cross sectional descriptive study conducted at Ain shams University Children’s Hospital Pediatric cardiology unit during the period from June 2017 till January 2018. Thirty IDMs were recruited. IDMs with CHD and HCM were excluded. We further subdivided them into 2 groups; Infants of gestational diabetic mothers (IGDM) and infants of pregestational diabetic mothers (IPGDM). They were all examined using TDI and STI echocardiography in the first week of life. This group was compared to a group of age and sex matched healthy controls. Results All IDMs had normal cardiac dimensions and global cardiac functions as controls, IVS (P = 0.434), LVED (P = 0.318), EF (P = 0.291), LVFS(P = 0.644) and GLS(P = 0.240). However, evidence of LV dysfunction proved by increased Tei index (p = 0.018). This subtle affection of myocardial function was more prominent in infants of IPGDM when compared to IGDMs (P = 0.004). Conclusion Subtle affection of myocardial functions may occur in IDMs even in the absence of morphological cardiac changes. This was detected by TDI. Neither conventional assessment of myocardial functions, nor STI are sensitive tools in detecting these changes. IPGDMs are at risk of more profound affection of myocardial function than infants of IGDMs.

Reproducibility of the assessment of myocardial function through tissue Doppler imaging in very low birth weight infants

2019 ◽  
Vol 36 (6) ◽  
pp. 1145-1152 ◽  
Author(s):  
Paula Méndez‐Abad ◽  
Pamela Zafra‐Rodríguez ◽  
Simón Lubián‐López ◽  
Isabel Benavente‐Fernández
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Tissue Doppler Imaging ◽  
Myocardial Function ◽  
Very Low Birth Weight ◽  
Tissue Doppler ◽  
Doppler Imaging ◽  
Low Birth Weight Infants

scholarly journals Biochemical and Physiological Characteristics of Neonates Born to Mothers with Diabetes During Gestation

2012 ◽  
Vol 31 (1) ◽  
pp. 47-52 ◽  
Author(s):  
Ljubomir Milašinović ◽  
Ivan Hrabovski ◽  
Zorica Grujić ◽  
Mirjana Bogavac ◽  
Aleksandra Nikolić
Keyword(s):  
Birth Weight ◽  
Glucose Homeostasis ◽  
Gestational Age ◽  
Newborn Infants ◽  
Physiological Characteristics ◽  
Control Group ◽  
High Birth Weight ◽  
Infants Of Diabetic Mothers ◽  
Group I ◽  
Diabetic Mothers

Biochemical and Physiological Characteristics of Neonates Born to Mothers with Diabetes During GestationThe aim of this study was to investigate how glucose homeostasis disorders influence biochemical homeostasis and fetal maturation. A prospective randomized study included 102 infants: 31 newborns of mothers with glucose homeostasis disorders (Group I) and 71 newborns of healthy mothers (Group II). In the pregnant women, the mean age, body weight and height, BMI, parity, duration of the disease and the mode of labor were estimated. The following procedures were performed in each newborn infant: physical examination, determination of Apgar score, measurements of birth weight and length, estimation of neurological status, clinical estimation of gestational age, ECG and ultrasonography of the brain, as well as the basic hematologic, biochemical and microbiological analyses. Newborn infants of diabetic pregnancies were small for gestational age and of high birth weight. The levels of Na+, K+and Cl-ions did not show significant differences between the investigated groups, whereas the levels of total Ca and Mg were significantly decreased (2.18±0.59 and 0.65±0.17 mmol/L) (p<0.001) in the investigated group relative to the control group (2.42±0.53 and 0.81±0.09 mmol/L). The newborn infants of diabetic pregnancies presented with significantly decreased values of phosphates, bicarbonates and pH, whereas the difference in total osmolality was not statistically significant. The level of glucose at birth in the infants of diabetic mothers was lower (2.91±0.51 mmol/L) (p<0.001) than in the infants of healthy pregnancies (3.94±0.29 mmol/L). Glycemia lower than 2 mmol/L was recorded in 6.5% of infants of the investigated group. The level of bilirubin was significantly increased (209.71±56.66 mmol/L) (p<0.001) in infants of diabetic mothers compared to those of the healthy ones (155.70±61.14 mmol/L), like the incidence of clinically manifested hyperbilirubinemia. Disorders of maternal glucose homeostasis cause biochemical disorders such as hypoglycemia, hypocalcemia, hyperbilirubinemia, hypomagne semia and are associated with impaired maturation and congenital malformations of the fetus.

scholarly journals Assessment of myocardial function in preterm infants with patent ductus arteriosus using tissue Doppler imaging

2013 ◽  
Vol 25 (1) ◽  
pp. 70-75 ◽  
Author(s):  
Ravikumar Parikh ◽  
Robert J. S. Negrine ◽  
Ashish Chikermane ◽  
Shree Vishna Rasiah ◽  
Andrew K. Ewer
Keyword(s):  
Patent Ductus Arteriosus ◽  
Preterm Infants ◽  
Performance Index ◽  
Myocardial Function ◽  
Ductus Arteriosus ◽  
Tissue Doppler ◽  
Myocardial Performance Index ◽  
Doppler Imaging ◽  
Myocardial Performance ◽  
Patent Ductus

AbstractObjective: To assess myocardial function in preterm infants with different degrees of ductal patency in the first week of life using tissue Doppler imaging. Study design: Infants <30 weeks of gestation underwent echocardiography on day 3. A total of 72 infants were recruited into the study and categorised into three groups (i) haemodyamically significant ductus arteriosus, (ii) patent ductus arteriosus and (iii) no patent ductus arteriosus. Those with haemodynamically significant ductus arteriosus were treated with indometacin and echocardiography was repeated after 48–72 hours following treatment. Peak systolic and diastolic myocardial velocities were obtained using tissue Doppler imaging, and myocardial performance index was calculated. Results: Initial myocardial velocities were significantly lower and myocardial performance index significantly higher in the haemodynamically significant ductus arteriosus group compared with other groups. For the haemodynamically significant ductus arteriosus group, post-treatment myocardial velocities were higher and myocardial performance index lower than pre-treatment. Conclusion: Preterm infants with haemodynamically significant ductus arteriosus had lower myocardial velocities and higher myocardial performance index, suggesting relative systolic and diastolic myocardial dysfunction. Babies whose patent ductus arteriosus remained open despite indometacin had lower pre-treatment myocardial velocities and higher myocardial performance index than those babies whose patent ductus arteriosus closed, suggesting worse myocardial function in this group. Measurement of myocardial function using tissue Doppler imaging in preterm infants is feasible and may prove to be helpful in the management of babies with patent ductus arteriosus.

Subclinical Decrease in Myocardial Function in Asymptomatic Infants of Diabetic Mothers: A Tissue Doppler Study

2017 ◽  
Vol 38 (4) ◽  
pp. 801-806 ◽  
Author(s):  
Jenny E. Zablah ◽  
Dorota Gruber ◽  
Guillaume Stoffels ◽  
Estefania G. Cabezas ◽  
Denise A. Hayes
Keyword(s):  
Myocardial Function ◽  
Tissue Doppler ◽  
Infants Of Diabetic Mothers ◽  
Doppler Study ◽  
Diabetic Mothers

scholarly journals Neonatal Outcomes of Large-for-Gestational Age Infants with or without Gestational Diabetes Mellitus

2018 ◽  
Vol 16 (2) ◽  
pp. 25-30
Author(s):  
Taslima Begum ◽  
Gulshan Ara Begum ◽  
Mahmood A Chowdhury ◽  
Wazir Ahmed ◽  
Md Badrudddoza
Keyword(s):  
Blood Glucose ◽  
Birth Weight ◽  
Gestational Diabetes ◽  
Respiratory Distress ◽  
Hospital Stay ◽  
Gestational Age ◽  
Neonatal Outcomes ◽  
Large For Gestational Age ◽  
Infants Of Diabetic Mothers ◽  
Diabetic Mothers

Background: Infants are considered Large for Gestational Age (LGA)if their birth weight is greater than the 90th percentile for gestational age. Birth weight is influenced by a number of factors with maternal diabetes being one of the most common risk factor affecting birth weight. They have an increased risk for adverse perinatal outcomes. The aim of the present study was to compare the neonatal outcomes of LGA infants delivered by women with and without gestational diabetes mellitus.Methods: This is a prospective study of all live-born LGA infants of 37 weeks of gestation with a birth weight of 4000g admitted at Neonatal ward of Chattagram Maa Shishu-O-General Hospital (CMSOGH) between 1st August 2013 to 31st July 2014. Type of sampling was purposive convenient sampling. A total of 51 neonatal patients were included. Data was collected in case record form. Data collected for the mothers included age, parity, gestational age and mode of delivery. Data for the infants include sex, birth weight, birth length and laboratory test. Outcomes were compared between infants of diabetic mothers (Group A) and infants of non- diabetic mothers (Group B). Then data was analyzed by SPSS 17.0 program and presented by tabular method, diagram and chart.Results: Among fifty one study subjects, thirty were Infants of Diabetic Mothers (IDMs) while twenty one were non- IDMs. 19 (63.3%) of the IDMs were male while 11 (36.7%) were female. Among the 21 non-IDMs 10 (47.6%) were male and 11 (52.4%) were female. Male to female ratio was 1.4:1. 5 (16.7%) of the IDMs were delivered vaginally while 25 (83.3%) were delivered by Caesarian Section (CS) where as 8 (38.1%) of the non- IDMs were delivered vaginally while 13 (61.9%) were delivered by CS. Respiratory distress was the most common morbidity affecting 70% of the IDMs and 66.7% of the non-IDMs. TTN accounted for the majority of the respiratory distress cases, occurring in 17 of the IDMs and 12 of the non-IDMs. Regarding analysis of other clinical features, convulsion (63.3%) was present more in IDMs than in non-IDMs (52.4%) cyanosis was found more in IDMs (60%) than non-IDMs (38.1%). Hypoglycemia was found more in IDMs than in non-IDMs. Mean glucose values were 41.06±19.91mg/dl for IDMs and 53.06±28.96mg/dl for the non-IDMs (p=0.001). Hyperbilirubinemia was more frequently observed in IDMs than in non- IDMs. About 17 (56.6%) of the IDMs and 7(33.3%) of the non-IDMs developed jaundice during the period of hospital stay. Polycythemia was not observed in both the groups but PCV was higher in IDMs (53.96±6.36) compared to non-IDMs (50.50±8.76). Hypocalcemia was not peculiar to a specific group. Five of the IDMs had congenital anomaly, of which three of them had cardiac anomaly. One of the non-IDM was suffering from ventricular septal defect. Birth asphyxia was observed more in non-IDMs (71.4%) than in IDMs (53.3%).One of the IDMs and two of the non-IDMs sustained a brachial plexus injury following vaginal delivery. On an average, IDMs had a longer duration of hospital stay. Outcome was more fatal in IDMs. About six (20%) of IDMs died compared to two (9.5%) of the non-IDMs. That was found statistically significant (p=<0.05).Conclusion: LGA babies with diabetic mother had more adverse outcome in terms of mortality and blood glucose level. More concentration is needed to control blood glucose of mother during pregnancy. Also extra care for the babies is needed to avoid fatal neonatal outcomes.Chatt Maa Shi Hosp Med Coll J; Vol.16 (2); July 2017; Page 25-30

scholarly journals A study of clinical, metabolic and hematological profile in infants of diabetic mothers

2014 ◽  
Vol 2 (02) ◽  
pp. 34-40 ◽  
Author(s):  
Girish Gopal
Keyword(s):  
Diabetes Mellitus ◽  
Congenital Heart Disease ◽  
Heart Disease ◽  
Birth Weight ◽  
Gestational Age ◽  
Congenital Anomalies ◽  
Congenital Heart ◽  
Neonatal Period ◽  
Infants Of Diabetic Mothers ◽  
Diabetic Mothers

Background:Diabetes has long been associated with maternal and perinatal mobidity and mortality. Infants of diabetic mothers (IDMs) have higher risks for serious problems during pregnancy, delivery and early neonatal period. Abnormal fetal metabolism during pregnancy which is complicated by maternal diabetes mellitus results in multiple neonatal sequelae. Objective: To study the clinical, metabolic and hematological profile in infants of diabetic mothers and to compare the neonatal outcome in gestational and pregestational (overt) diabetic mothers. Methods: 69 neonates born to diabetic mothers were enrolled in the study. Gestational age, birth weight, relevant perinatal history and examination findings were recorded. Blood samples were collected to perform relevant biochemical tests and managed as per unit protocol. Echocardiography and ultrasound abdomen was done routinely in all neonates. Results: Of the 69 neonates, 71.01% (49/69) were born to mothers with gestational diabetes mellitus (GDM), while the remaining 28.99% (20/69) were born to mothers with pregestational (overt) diabetes mellitus (PGDM). 53.63% (37/69) of mothers had poor glycemic control. Most of the neonates (73.91% - 51/69) were delivered by cesarean section. 88.40% (61/69) of the babies were born at term. Majority of them (85.50% - 59/69) were appropriate for gestational age with mean birth weight of 3.06±0.82kgs. Hypoglycemia was the most common metabolic abnormality seen in 73.91% (51/69) of neonates. Polycythemia was seen in 60.80% (42/69) of neonates. Congenital malformations were seen in 17.40% (12/69) of neonates, of which most of them had congenital heart disease. 11.60% (8/69) of the babies had suffered birth injuries. 5.80% (4/69) of neonates died in the early neonatal period. Occurrence of hypoglycemia, polycythemia, hyperbilirubinemia, congenital anomalies and birth injuries were significantly higher in infants born to mothers with GDM, whereas hypocalcemia and hypomagnesemia were significantly higher in infants of mothers with PGDM. Conclusions: Among the pregnancies complicated by diabetes, GDM continues to have a major contribution. Hypoglycemia and polycythemia remain the most common biochemical and hematological abnormality respectively. Congenital heart disease forms a major proportion of the congenital anomalies seen in IDMs. Mortality rate is higher in infants born to mothers with GDM.

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