Is Routine Monitoring for Hypoglycemia Required in Intramural Asymptomatic Infant of Diabetic Mother? An Audit in a Tertiary Care Hospital

Aims This retrospective audit aimed to analyze whether routine frequent monitoring for hypoglycemia is required in asymptomatic infant of diabetic mother born in tertiary care hospital. Methods The study analyzed the blood sugar level of 196 infants of diabetic mothers. Results The overall incidence of hypoglycemia from 196 study participants was 9.18% (N = 18). The incidence of hypoglycemia at 2 h of life was maximum (83.33%) and it was significant when compared to 3, 6, 9 and 12 h (p < 0.0001). Blood glucose levels were significantly more at 6 (p = 0.0002)), 9 (p = 0.0001) and 12 h (p = 0.0001) when compared to glucose level at 2 h except at 3 h of life (p = 0.062). Similarly blood glucose at 9 (p = 0.0001) and 12 h of life (p = 0.0002) were significantly more than at 3 h of life. Blood glucose at 9 h was significantly more than at 6 h of life (0.032) and at 12 hours of life (p = 0.0237) was significantly higher than at 6 h of life. Conclusion The frequent blood glucose monitoring for hypoglycemia in infant of diabetic mother as per American Academy of Pediatrics may be reduced as per the findings in our study. However, this needs to be confirmed by a properly designed observational study/adequately powered randomized controlled trial.

Incidence of hypoglycemia in newborns with risk factors

Background: The incidence of hypoglycemia varies worldwide according to the protocols and feeding Policies. There is paucity of data on Incidence of hypoglycemia in institutions where exclusive breastfeeding is followed. Objectives of this study was to study the incidence of hypoglycemia in newborns with risk factors and to study the differences in incidence between at risk groups.Methods: The Observational study was conducted in babies born with risk factors for hypoglycemia, infant of diabetic mother (IGDM/IDM), LGA (birthweight >90th percentile), SGA (birth weight <10th percentile), low birth weight (>1800 to <2500 grams) and preterm (35 - 37 weeks). babies on formula or pre-lacteal feed, major congenital malformations and admitted in NICU for other reasons were excluded. Hypoglycemia screening was done at 2, 6, 12, 24 and 48 hours of life, prior to feeding.Results: The incidence of hypoglycemia in newborns with risk factors was 33.3%. Out of 1883 Babies born with risk factors, 627 Babies developed at least one episode of hypoglycemia. Of these, 576 (30.3%) were asymptomatic hypoglycemia and 51 (3.0%) symptomatic hypoglycemia. Hypoglycemia was seen in 42% of SGA, 33% of IDM, 19% of preterm and 10% of LGA babies. About 51% of newborns developed hypoglycemia at 2 hours of life and about 31% of newborns at 6 hours of life. No hypoglycemic episodes were noted after 24 hours of life.Conclusions: Hypoglycemia screening should be done at regular interval, more specifically at first 24 hours of life in at risk babies where Exclusive Breastfeeding is followed.

Gestational diabetes mellitus with its maternal and foetal outcome: a clinical study

Background: Prevalence of the diabetes among pregnant women is increasing, attributable to advance maternal age, multi foetal gestation, increased body mass index, strong family history, sedentary life style, change in the diet, continued immigration. Gestational diabetes has few symptoms, commonly diagnosed by screening during pregnancy.Methods: The present study was conducted at Department of Medicine and Department of Obstetrics and Gynaecology, Dr. S.N. Medical College, Jodhpur. Rajasthan, India.Results: Out of 476 patients attending the antenatal outdoor at the Umaid Hospital, Jodhpur, Rajasthan, India. The prevalence of gestational diabetes in present study was 7.98%, Incidence of GDM found to increase with increasing age with maximum prevalence (10.71%) in more than 30 years age group, with increasing parity, low socioeconomic strata and in urban population. With maximum prevalence amongst higher parities (12.5%) in >G5 and higher). The incidence was higher with history of PIH (36.36%), family H/O DM (33.3%), GDM (12.12%), perinatal losses (15.15%), anomalous baby (9.09%), high BMI (67%). GDM complicate the normal course of pregnancy with increased incidence of PIH (36.4), Polyhydramnios (27.2%), infections like vaginal candidiasis (24.2%) and UTI (39.3%). The infant of diabetic mother had 12 (32.29%), 9 (26.47%), 11 (32.35%), 8 (23.53%) 5 (14.70%) and 3 (8.82%) of hypoglycemia, respiratory distress, macrosomia, congenital anomalies, birth injuries, polycythaemia, and hypocalcaemia respectively in diabetic mothers with suboptimal glycaemic control during pregnancy.Conclusions: GDM continues to be an important obstetrical condition with significant feto-maternal morbidity. Complications in infant of diabetic mother are more common with those mothers who had poor glycaemic control.

Morbidities and Mortalities among Infant of Diabetic Mother in a Newly Established Scabu of a Tertiary Care Hospital, Bangladesh

Introduction: Diabetes mellitus has long been associated with perinatal morbidity and mortality. It complicates 2% to 3% of all pregnancies; 90% of these cases present with gestational diabetes mellitus. In our population Gestational diabetes mellitus develops among 6.7% of all pregnancies. Macrosomia (28%), hypocalcaemia (22%), hyperbillirubinaemia (19%), polycythemia (34%), perinatal asphyxia, birth injury and congenital anomaly (6-9%) are the complications of infant of diabetic mother (IDM).Materials and Methods: This prospective observational study was done in the newly established Special Care Neonatal Unit (SCANU) to determine the morbidities and mortalities among IDM babies admitted in to Mymensingh Medical College Hospital (MMCH), Bangladesh from January to March 2015. A total 50 IDM patients who admitted during this period were recruited in the study irrespective of their gestational age, birth weight, pattern and duration of maternal diabetes.Results: Male and female patients were 29 (58%) and 21 (42%). Caesarian and vaginal delivery were 43 and seven cases. Gestational and pre-gestational diabetes mothers were 35 (70%) and 15 (30%) respectively. The important morbidities in order of frequency were found perinatal asphyxia (50%), macrosomia (48%), neonatal jaundice (44%), hypoglycaemia (40%), hypocalcaemia (36%), polycythemia (28%), CHD (20%), neonatal sepsis (20%), birth trauma (12%), TTN (6%), RDS (6%), GIT problem (2%) respectively. Mortality was recorded in three patients. Conclusion: Our observations show the high prevalence of IDM (24/1000 live birth) and their various complications. Mortality and morbidity is a bit higher in IDM. Our health policy maker should give adequate emphasis on management of IDM babies.J Nepal Paediatr Soc 2015;35(3):253-256