Fluid status changes during the transition in infants of diabetic mothers.

Vincenzo Zanardo,Matteo Parotto,Pietro Guerrini,Domenico Tortora,Lorenzo Severino,Gianluca Straface

doi:10.1007/s00431-021-04197-7

Vincenzo Zanardo, Matteo Parotto + Show 4 more

Open Access

https://doi.org/10.1007/s00431-021-04197-7

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Abstract

In animal and human neonates, expansion of the extracellular fluid volume is associated with "wet" lung and poor respiratory outcomes. To define fluid status changes during the transition from fetal to neonatal life in infants of diabetic mothers (IDM), we conducted a single-centre (Policlinico Abano Terme, Abano Terme, Italy) study of 66 IDM and a 1:2 matched control group from January 1 to September 30, 2020. Fluid status changes were assessed by computing Δ Hct from umbilical cord blood at birth and capillary heel Hct at 48h, accounting for body weight decrease. IDM presented with significantly lower cord blood Hct levels in comparison to controls (47.33 ± 4.52 vs 50.03 ± 3.51%, p < 0.001), mainly if delivered by elective cesarean Sect.(45.01 ± 3.77 vs 48.43 ± 3.50%, p = 0.001). Hct levels at 48h were comparable (55.18 ± 5.42 vs 54.62 ± 7.41%, p = 0.703), concurrently with similar body weight decrease (- 217.21 ± 113.34 vs - 217.51 ± 67.28g, p = 0.614). This supports significantly higher ∆ Hct in IDM (5.13 ± 5.24 vs 7.29 ± 6.48, p < 0.01) and extra circulating fluid loss of 2-3%.Conclusion: Gestational diabetes is associated with an excess of circulating fluids during the transition from fetal to neonatal life, challenging the current assumption that is per se at risk of wet lung. What is Known: • In neonates, evidence suggests that expansion of the extracellular fluid volume prior to the postnatal diuresis is associated with poor respiratory outcomes. What is New: • Gestational diabetes is associated with an excess of circulating fluids during the transition from fetal to neonatal life, challenging the current assumption that is per se at risk of wet lung.

Highlights

The body composition of the fetus changes during gestation with a smaller proportion of body weight composed of water as gestation progresses [1]
infants of diabetic mothers (IDM) presented with significantly lower cord blood Hct levels in comparison to controls (47.33±4.52 vs 50.03±3.51%, p
Gestational diabetes is associated with an excess of circulating fluids during the transition from fetal to neonatal life, challenging the current assumption that is per se at risk of wet lung

Summary

Introduction

The body composition of the fetus changes during gestation with a smaller proportion of body weight composed of water as gestation progresses [1]. In animal and human neonates, evidence suggests that expansion of the extracellular fluid volume prior to the postnatal diuresis is associated with poor neonatal respiratory outcomes, as an essential part of the rapid change from the “wet” lung of the fetus to the “dry” lung needed by the neonate for gas exchange [3,4]. Fetal lung fluid, which is in essence amniotic fluid, contains very little protein and has a low colloid osmotic pressure It is removed by Increased pulmonary perfusion, which pulls lung fluid from the alveoli across the capillary membrane [5]. It seems clinically relevant to consider that the pulmonary function in premature neonates requiring mechanical ventilation deteriorates until the onset of diuresis, after which it rapidly improves [6] This diuresis may represent the removal of excess lung liquid and seems necessary for improvement in lung function. In animal and human neonates, expansion of the extracellular fluid volume is associated with “wet” lung and poor respiratory outcomes

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