Abstract
After peripartum asphyxia, metabolic acidosis and neurological derangement are clinical findings. In severe cases, treatment with hypothermia should be started within six hours after birth. A rare cause of neonatal metabolic acidosis is maternal metabolic derangement due to Diabetic Keto Acidosis (DKA). We report characteristics of a boy born at 336/7 weeks gestation to a mother with unrecognized DKA in gestational diabetes mellitus. Persistent metabolic acidosis and severe neurological derangement resulted. Diagnosed as severe peripartum asphyxia, hypothermia was started. Hours after delivery, the mother was diagnosed with DKA. Although the child’s diagnosis of peripartum asphyxia was revised, hypothermia was continued. In newborns with severe metabolic acidosis and normal serum lactate, maternal metabolic derangement due to DKA should be considered. In those cases hypothermia is not proven effective. Early recognition and treatment of maternal DKA potentially prevents fetal death, neonatal sequelae and in less severe cases, unnecessary invasive hypothermic therapy.
Highlights
Metabolic acidosis directly postpartum is a common feature in the term neonate
Little is known about neonatal sequelae of maternal Diabetic Keto Acidosis (DKA)
All require a different therapeutic approach. In this case report we report a preterm infant with metabolic acidosis as a result of unrecognized maternal DKA, treated invasively as peripartum asphyxia
Summary
Metabolic acidosis directly postpartum is a common feature in the (pre-) term neonate. The number one cause of metabolic acidosis shortly after delivery is peripartum asphyxia. A rare cause of neonatal metabolic acidosis is maternal metabolic derangement due to Diabetic Keto Acidosis (DKA).
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Published Version
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