Neonates Of Diabetic Mothers Research Articles

Frequency and Patterns of Congenital Heart Defects in Neonates of Diabetic Mothers at a Tertiary Care Hospital

Objective: To assess the incidence and spectrum of Congenital Heart Defects (CHDs) in neonates born to mothers with Gestational Diabetes Mellitus (GDM), compared to those born to non-diabetic mothers. Methodology: This retrospective comparative study was conducted at the Department of Pediatric Cardiology, Bahawal Victoria Hospital, Bahawalpur, over one year from September 2023 to September 2024. A total of 260 neonates were included and divided into two groups: 130 born to mothers with GDM and 130 to non-diabetic mothers. Inclusion required complete maternal antenatal and neonatal records. Neonates with syndromic features or known chromosomal anomalies were excluded. Maternal glycemic status was verified from antenatal clinic files, and CHD diagnosis was based on echocardiography performed within the first week of life. The frequency and types of CHDs were recorded and compared. Data were analyzed using SPSS version 26.0, with p < 0.05 considered statistically significant. Results: CHDs were significantly more common among neonates of diabetic mothers (15.4%) compared to non-diabetic mothers (4.6%) (p < 0.01). Patent foramen ovale (PFO) and atrial septal defect (ASD) were significantly higher in the diabetic group—10% vs. 3.1% and 11.5% vs. 3.8%, respectively. Although not statistically significant, increased frequencies of ventricular septal defect (VSD), patent ductus arteriosus (PDA), dextro-transposition of the great arteries (dTGA), and tetralogy of Fallot (TOF) were also noted in neonates of diabetic mothers. Conclusion:Neonates born to mothers with GDM are at a significantly higher risk of developing congenital heart defects, emphasizing the need for early fetal cardiac evaluation and targeted postnatal screening in this high-risk group.

Usefulness of Glucose Monitoring in Neonates of Mothers With an Elevated Glucose Challenge Test and a Normal Oral Glucose Tolerance Test.

Background Neonatal hypoglycemia is a common metabolic disturbance in neonates. Glucose monitoring is recommended for certain groups of neonates, including those whose mothers have pre-gestational or gestational diabetes. Little is known about the relevance of glucose monitoring in neonates whose mothers have an elevated screening glucose challenge test (GCT) but a normal oral glucose tolerance test (OGTT). Objectives The objectives of this study were to determine if neonates of mothers with an elevated GCT but a normal OGTT had hypoglycemiaand to establish if there was anassociation between the maternal GCT and neonatal blood glucose level. Methods A single-site retrospective analysis was conducted on 307 neonates born in a community hospital in the Brooklyn area of New York between November 1, 2021, and November 1, 2023, who were identified as being at risk for hypoglycemia due to known risk factors like maternal diabetes, prematurity, low birth weight, and small or large size for gestational age,as well as possible risk factors like an elevated maternal GCTbut a normal OGTT. Glucose monitoring had been done for these neonates at birth per AAP recommendations. The Office of Science and Research Institutional Review Board reviewedthe study which was determined to meet the criteria for exemption. The individual authorization requirements were waived and adequate steps were taken to ensure data privacy. Neonates ofdiabetic mothers or mothers with an elevated OGTTand neonates who were born preterm, low birth weight, and small or large for gestational age were excluded from the study while neonates whose mothers had an elevated GCT,but a normal OGTT were included. This brought to 63 the number of neonates who met the inclusion criteria. Charts were reviewed to see if these neonates had hypoglycemia during the course of glucose monitoring. The chi-square test was used for categorical variables and the two-samplet-testwas used for continuous variables. Results In our study, eight of the 63 neonates had asymptomatic hypoglycemia while the rest were euglycemic. None required admission to the neonatal intensive care unit and the hypoglycemia resolved with oral feed, oral glucose gel, or a combination of the two. Although hemoglobin A1c was also elevated in eight of the 63 mothers, all the mothers of the neonates with hypoglycemia had normal hemoglobin A1c, and no relationship was found between the hypoglycemic reaction (X2 = 0.927) and hemoglobin A1c in the mothers who had an elevated GCT but a normal OGTT. The male-to-female ratio was approximately 1:1, and there was no relationship between gender and neonatal hypoglycemic reaction (X2 = 0.002). There was also no correlation between maternal GCT and initial (r=-0.173) or lowest (r=-0.182) neonatal glucose readings. Conclusion Our studydemonstrated that the likelihood of hypoglycemia in neonates of mothers with an abnormal GCT, but a normal OGTT was slim.Further studies are needed, and a larger group size would be ofbenefit.

Pattern and Frequency of Congenital Heart Defects Among Infants of Diabetic Mothers.

Background Maternal diabetes mellitus (DM) is a known risk factor for congenital heart diseases (CHDs), which are of significant concern to infants born to diabetic mothers. Compared to newborns born to non-diabetic mothers, infants born to diabetic mothers had a higher overall risk of developing congenital malformations. This association has a complex pathophysiology that includes genetic predispositions, metabolic abnormalities, and environmental factors during key stages of fetal development. By developing screening strategies for neonates born to diabetic mothers, it will be imperative to reduce preventable neonatal mortality by healthcare providers. Purpose The primary objective of this study was to explore the spectrum of congenital heart defects (infants of diabetic mothers, IDMs). Methods This exploratory study was conducted at the maternity and children's hospital in AlAhsa, Saudi Arabia, from 2022 to 2023. The study included 401 neonates delivered at our institution. Within the first seven days of life, an expert pediatric cardiologist from the same institute performed echocardiography on all patients. Results A total of 401 infants born to diabetic mothers were selected, with 293 meeting the inclusion criteria. In total, 144 (49.1%) were boys and 149 (50.9%) were girls. Nearly more than half of mothers (189, 64.5%) had gestational diabetes, while 104 (35.5%) had pre-gestational diabetes. Out of 293 infants born to diabetic mothers, 200 (68.3%) had various CHDs, while the remaining 93 (31.7%) were found to be normal after echocardiography. The most commonly reported CHD is patent ductus arteriosus (PDA) (71.5%), followed by hypertrophic cardiomyopathy (36.5%) and ventricular septal defect (VSD) (11%), and only one patient has a complex congenital heart disease. Conclusion More than half of the infants born to diabetic mothers had congenital heart defects, according to the current study, which examined the various types of congenital heart diseases in neonates of diabetic mothers. It thus emphasizes the necessity of a thorough evaluation and the strong recommendation for an early diagnosis of CHD in this high-risk group. In our population, prenatal CHD screening programs need to be developed.

Assessment of neonatal glycaemic status and comorbidities in infants of diabetic mothers admitted to the neonatal care unit of Al-Ramadi Teaching Hospital for maternity and childhood, Iraq.

To assess neonatal and maternal characteristics, glycaemic status and comorbidities in the neonates of diabetic mothers. The cross-sectional study was conducted from October 2021 to May 2022 at the Department of Physiology, College of Medicine, University of Mustansiriyah, Baghdad, Iraq, and comprised healthy women. Samples were raised by simple random technique. Digital pulse waves were captured using a fingertip pulse wave transducer. Lab Chart Pro version 7.2 was used to automatically detect and quantify the amplitude of A, B, C, D and E waves expressed by the second derivative. QT interval of each beat was recorded by electrocardiogram, and was calculated automatically via Lab chart Pro version 7.2 without averaging. Data was spread out on Microsoft Office Excel 2013 and analysed using SPSS version 26. Among the 70 mothers, aged between 18 to 44 years, gestational diabetes was the commonest type 52(74.3%), and, among the 70 neonates, 52(74.3%) developed mild hypoglycaemia, 12(17.1%) hypocalcaemia, 26(37.1%) congenital heart disease, 50(71.4%) respiratory distress syndrome, 24(34.3%) hyperbilirubinaemia, 2(2.9%) congenital anomalies, 6(8.6%) prematurity, and 4(5.7%) developed birth asphyxia. Prematurity, female gender and low birthweight were significantly associated with hypoglycaemia (p<0.05). No significant differences were detected in terms of neonatal complications between pregestational and gestational diabetic mothers (p>0.05). Diabetic pregnancies were linked to a higher risk of neonatal complications.

Association between Cord Blood Haematocrit and Neonatal Outcome among Neonates of Diabetic Mothers: A Cohort Study

Introduction: The perinatal mortality rate of Neonates of Diabetic Mothers (NDMs) over the years showed a reducing trend. Polycythaemia is common in NDMs, and such neonates have a risk of hyperviscosity, renal vein thrombosis, cardiac failure, metabolic abnormalities, and necrotising enterocolitis. Aim: To assess the association between cord blood haematocrit and neonatal outcomes among NDMs. Materials and Methods:The present study was a cohort study that included 130 neonates, which was conducted at Amala Institute of Medical Sciences (AIMS), Thrissur, Kerala, India, from December 2019 to June 2021. The primary inclusion criteria were singleton neonates of Gestational Diabetic Mothers (GDM) (diabetes detected after 20 weeks of gestation) and Overt Diabetes Mellitus (ODM) defined under White’s classification (known to be diabetic before the onset of pregnancy or detected in the initial visits). The parameters assessed were the frequency of distribution of hypoglycaemia, hypocalcaemia, and hyperbilirubinemia among the neonates of DM. Statistical analysis was done using Fisher’s exact test and Student’s t-test. Results: Among the 130 neonates, the majority of the mothers had GDM 111 (85.4%) than ODM 19 (14.6%). The majority were delivered by normal vaginal delivery 67 (51.5%). 10 (7.7%) of NDMs had a birth weight &gt; 4000 g. Significant associations were noted between cord Packed Cell Volume (PCV) and the presence of hypoglycaemia (p-value=0.003), hypocalcaemia (p-value=0.0001), and Neonatal Hyperbilirubinemia (NNH) (p-value=0.0001) among NDMs. Conclusion: Hypoglycaemia, hyperbilirubinemia, and hypocalcaemia were common complications noted in NDMs.

Immediate Outcomes in Neonates Born to Diabetic Mothers

Background: Infants born to diabetic mothers are at a higher risk of developing complications like macrosomia, hypoglycemia, hypocalcemia, hypomagnesemia, polycythemia, hyperbilirubinemia, prematurity, transient tachypnea of newborn, respiratory distress syndrome, birth asphyxia, congenital heart diseases etc. The predominant causes of mortality are congenital anomaly, birth trauma, respiratory distress syndrome, prematurity and unexplained still birth. Hence this present study was conducted to study the incidence of complications among neonates of diabetic mothers. Materials and Methods: This was hospital-based observational study conducted in NICU and postnatal ward of a tertiary care hospital among 55 neonates. A detailed maternal history and complications during labor were recorded. Investigations like glucose estimation, PCV, serum calcium, serum bilirubin were done. The incidence of complications was assessed in terms of frequency and percentage. Results: Complications related to maternal diabetes were observed among 33 (18.15%) neonates. They were hypoglycemia, hypocalcemia, hyperbilirubinemia and polycythemia. Among them, hypoglycemia was the most common complication observed among 13(23.63%) neonates followed by hyperbilirubinemia among 10 (18.18%) neonates. Conclusion: Hypoglycemia was the most common complication followed by hyperbilirubinemia among infants born to diabetic mothers.

The spectrum of congenital heart defects in neonates of diabetic mothers

Introduction: Insulin-dependent diabetes mellitus (IDDM) in a mother is considered a risk factor for congenital malformation, including congenital heart diseases. Many studies signify a five to six times increased frequency of congenital heart diseases in neonates born from insulin-dependent diabetic mothers. This study aimed to identify the spectrum of congenital heart diseases (CHDs) in neonates born from insulin-dependent diabetes mellitus (IDDM) mothers. Methods: Between April 2019 and March 2021, a descriptive cross-sectional study involved 120 consecutive neonates aged 0-28 days of mothers with insulin-dependent diabetes mellitus (IDDM) at Maiwand Teaching Hospital, Kabul University of Medical Sciences. Neonates born to non-diabetic mothers were excluded. IDDM refers to mothers using Insulin upon admission to control blood glucose. CHD encompasses various heart defects affecting function. Family and maternal history were noted, focusing on health issues and delivery details. Neonatal mothers' ages ranged from 23 to 45 (mean 33), with diabetes onset spanning 2.5 to 25 years. Pediatric cardiologists conducted physical and echocardiographic exams. All CHD forms were documented using 2D echocardiography and Doppler studies (Sono Ace X-6 Machine). Result: 120 consecutive neonates born to mothers with insulin-dependent diabetes mellitus (IDDMs) were investigated during the two-year study period. Of them, 18 (15%) had congenital heart abnormalities. The prevalence of solitary and multiple CHD was 66.6 percent (12 patients) and 33.3 percent (6 patients) in the 18 infants born from IDDMs. The most prevalent isolated defects were PDA (22.2%) and Ventricular septal defect (16.6%). The most common multiple CHDs (16.6 percent) were PDA and ASD. PDA + ASD (16.6%) and VSD + PDA were the most frequent correlations with CHD (11.1 percent). Conclusion: Maternal insulin-dependent diabetes mellitus is an important risk factor for congenital heart disease. Careful assessment and early diagnosis of CHD in this high-risk group are very important in a pediatric population. Expansion of prenatal screening programs for CHDs in mothers suffering from insulin-dependent diabetes mellitus is necessary. Keywords: congenital heart diseases; diabetic mothers; insulin dependent; neonates

Prevalence of Hypertrophic Cardiomyopathy in Neonates of Diabetic Mothers: A Six-month Follow-up Study

Background: Hypertrophic cardiomyopathy (HCM) is known to be the most common cardiac disorder in fetuses of diabetic mothers, especially when diabetes is not controlled in pregnancy. This study aimed as to estimate the prevalence of HCM in neonates born to diabetic mothers and to evaluate therapeutic interventions with follow-up after six months. We also focused on the possible association of neonatal HCM with the maternal type of diabetes.&#x0D; Methods: A cross-sectional study was conducted between October 2016, and September 2017, in the Cardiac Clinic of Yazd, a city in the center of Iran. The subjects were 150 neonates of mothers with diabetes. We determined HCM through fetal echocardiography before treatment and assessed the maternal and fetal factors. Finally, after a 6-month follow-up period, the data were analyzed statistically.&#x0D; Results: According to the results, the prevalence of HCM in neonates of diabetic mothers was 14% (P &lt; 0.0001). The results showed that there is a relationship between maternal uncontrolled diabetes and the incidence of HCM in the infant (P &lt; 0.0001), but there is no relationship between the type of diabetes and the incidence of HCM. Our results also showed that propranolol was effective in improving HCM, and spontaneous recovery of HCM was low in infants.&#x0D; Conclusion: We concluded that controlling maternal diabetes has the greatest effect on the prevention of HCM in neonates. Also, neonates of diabetic mothers need more heart tests and follow-ups. Therefore, more studies on the effects of maternal diabetes-induced HCM in neonates are needed.

Perinatal Outcome among Women with Gestational Diabetes Mellitus

Background &amp; Objectives: Diabetes in pregnancy is associated with an increased risk of complications in both the mother and the fetus. Early diagnosis by the screening of pregnant women between 24 to 28 weeks of gestation with proper control of diabetes is important to reduce the adverse effects in perinatal outcomes. This study aims to know the perinatal outcome among neonates of diabetic mothers in comparison with those of non-diabetic mothers. Methods: A case control study was carried out at Maternity Teaching Hospital in Erbil City, Kurdistan Region, Iraq over 6 months’ period, from 1st April 2019 to 1st 0f January 2020. A convenient sample size of 100 participants of diabetic mothers compared with 100 non-diabetic mothers with ? 34 weeks of gestation till one week post-delivery, perinatal outcome including gestational age, mode of delivery, admission to neonatal care unit, birth weight, gender, early neonatal death, intrauterine death, the intrauterine fetal restriction was measured in both groups. Results: Among majority of gestational diabetic mothers regarding to maternal age 33.5% were aged between 18-35 years, 16.5% were older than 35, the most common complications in gestational diabetes group which were statistically significant were hypoglycemia, polycythemia and respiratory distress( 17.5%, 13% and 20% respectively) , neonatal macrosomia were revealed in 22.5% of gestational diabetes mellitus neonates and only 10% in non- gestational diabetes mellitus revealed, Conclusion: Morbidities like hypoglycemia, macrosomia, polycythemia, and respiratory distress syndrome are more common among babies of diabetic mothers when compared to those of non-diabetic mothers, and they are the most common complications that were observed.

Prevalence of Congenital Heart Diseases in Neonates of Diabetic Mothers: A Cross Sectional Study in Yazd

Background: Maternal hyperglycemia is a critical risk factor for congenital heart diseases (CHD). Despite advancements in the medical management of diabetic mothers, the CHD in their infants are still more recurring compared to infants of the general population. The primary purpose of this investigation was to explore the prevalence of CHD in infants of diabetic mothers (IDMs). The study was also aimed at investigating possible associations between the types of maternal diabetes with the incidence of CHD in IDMs especially the status of diabetic control.&#x0D; Methods: This cross-sectional study was performed between October 2016 and September 2017, in a Heart Center in Yazd. The cases were comprised of 150 neonates of mothers with diabetes. We determined CHD via fetal echocardiography during the first day of childbirth and estimated the prevalence of CHD in IDMs and its association to control status of diabetes in mothers.&#x0D; Results: The prevalence of CHD in IDMs was 12.7%. The results showed that there was a significant relationship between maternal uncontrolled diabetes and a high incidence of CHD in IDMs (P ≤ 0.0001), but there was no association between the type of diabetes and the incidence of HCM.&#x0D; Conclusion: We concluded that controlling maternal diabetes has the greatest effect on the prevention of CHD in neonates. The prevalence of CHD in IDMs was 12.7% which is high that may be due to poor control of diabetes in pregnant women in Iran. Also, neonates of diabetic mothers need more cardiac evaluation tests and follow-ups. Therefore, more studies on the effects of maternal diabetes-induced CHD in neonates are needed.

Differential effects of delayed cord clamping on bilirubin levels in normal and diabetic pregnancies

Delayed cord clamping increased the risk of jaundice in newborns born to diabetic mothers, but had no effect in newborns from mothers with normal pregnancies. DCC may be a risk factor for increased bilirubin in infants of diabetic mothers. ClinicalTrials.gov: NCT04369313; date of registration: April 27, 2020 (retrospectively registered). • Delayed cord clamping had significant benefits for newborns by increasing neonatal hemoglobin levels and reducing the risk of neonatal anemia, etc. • Delayed cord clamping may lead to neonatal hyperemia, erythrocytosis, and hyperbilirubinemia, which increases the risk of neonatal jaundice. • Our trial focused on the differential effects of delayed cord clamping on jaundice in full-term newborns between diabetic pregnancies and normal pregnancies. And newborns of diabetic mothers who received delayed cord clamping had a significantly increased risk of jaundice compared to newborns with normal pregnancy. • Delayed cord clamping may be a risk factor for increased bilirubin levels in neonates of diabetic mothers.

Emotional Prosodies Processing and Its Relationship With Neurodevelopment Outcome at 24 Months in Infants of Diabetic Mothers.

Gestational diabetes mellitus (GDM) is one of the most common complications of pregnancy. Hyperglycemia of pregnancy is a risk not only for later obesity of the offspring but also do harm to their neurodevelopment from fetus. An ERP research has shown that children with autism spectrum disorder (ASD) was characterized by impaired semantic processing. In this study, we used event-related potential (ERP) to assess the procession of different emotional prosodies (happy, fearful, and angry) in neonates of diabetic mothers, compared to the healthy term infants. And to explore whether the ERP measure has potential value for the evaluation of neurodevelopmental outcome in later childhood. A total of 43 full-term neonates were recruited from the neonatology department of Peking University First Hospital from December 1, 2017 to April 30, 2019. They were assigned to infants of diabetic mothers (IDM) group (n = 23) or control group (n = 20) according to their mother's oral glucose tolerance test's (OGTT) result during pregnancy. Using an oddball paradigm, ERP data were recorded while subjects listened to deviation stimulus (20%, happy/fearful/angry prosodies) and standard stimulus (80%, neutral prosody) to evaluate the potential prognostic value of ERP indexes for neurodevelopment at 24 months of age. Results showed that 1) mismatch response (MMR) amplitudes in IDM group were lower than the control; 2) lower MMR amplitude to fearful prosody at frontal lobe was a high risk for increased Modified Checklist for Autism in Toddlers (M-CHAT) scores at 24 months. These findings suggests that hyperglycemia of pregnancy may influence the ability to process emotional prosodies in neonatal brain; it could be reflected by decreased MMR amplitude in response to fearful prosody. Moreover, the decreased MMR amplitude at the frontal lobe may indicated an increased risk of ASD.

Effect of later cord clamping on umbilical cord blood gas in term neonates of diabetic mothers: a randomized clinical trial

ObjectiveTo evaluate the effect of later cord clamping (LCC) on umbilical arterial blood gas in neonates of diabetic mothers.MethodsThis prospective study included a group of 160 diabetic mothers (DM) whose neonates were randomized to immediate cord clamping (ICC) (≤ 15 s after birth) or LCC (≥ 30 s after birth), and a group of 208 non-diabetic mothers (NDM) whose neonates were randomized to ICC or LCC as a reference. Cord arterial pH, base excess (BE), bicarbonate (HCO3−), partial pressure of carbon dioxide (pCO2), partial pressure of oxygen (pO2), lactate, hemoglobin, hematocrit and glucose were compared among groups.ResultsIn neonates of DM, there was no significant difference in cord arterial pH between the ICC and LCC group. LCC of ≥ 30 s decreased umbilical arterial HCO3− and BE and increased lactate (ICC versus LCC, HCO3−: 24.3 (22.7, 25.8) versus 23.7 (22.3, 24.7) mmol/L, P = 0.01; BE: -2.70 (-4.80, -1.50) versus − 3.72 (-5.66, -2.36) mmol/L, P = 0.006; lactate: 2.1 (1.6, 3.7) versus 2.7 (2.1, 4.3) mmol/L, P = 0.005), without the alterations of pCO2, pO2, hemoglobin, hematocrit and glucose. Similar results were found in neonates of NDM (ICC versus LCC, HCO3−: 24.3 (23.1, 25.7) versus 23.5 (22.3, 24.8) mmol/L, P = 0.01; BE: -2.39 (-3.73, -1.51) versus − 3.40 (-4.73, -1.91) mmol/L, P = 0.001; lactate: 2.2 (1.9, 3.3) versus 2.5 (2.0, 4.3) mmol/L, P = 0.01), except for the higher level of hemoglobin in the LCC group. The majority of diabetic mothers (ICC: 92.0%; LCC: 91.8%) had good blood glucose control. No differences were observed in acid-base status and glucose between neonates of DM and neonates of NDM in both ICC and LCC, but hemoglobin and hematocrit were elevated after ICC in neonates of DM compared to neonates of NDM.ConclusionsLater cord clamping of ≥ 30 s resulted in a tendency towards metabolic acidosis of umbilical arterial blood in neonates of DM and NDM. Umbilical arterial blood gas parameters at birth were similar in neonates of DM and NDM.Trial registrationClinicalTrials.gov: NCT04369313; date of registration: 30/04/2020 (retrospectively registered).

A Prospective Case-Control Study to Compare the Clinical Outcomes and Metabolic Profile in Neonates Born to Diabetic Mothers in a Tertiary Care Armed Forces Hospital, India

Introduction: The prevalence of gestational diabetes mellitus (GDM) is on the rise especially in women of Asian ethnicity. GDM carries with it a multitude of foeto-maternal complications, the management of which is still a challenge, especially in developing countries. Methods: This was a hospital based prospective case control study conducted on 100 neonates to compare clinical outcomes and metabolic profiles in neonates of diabetic mothers and neonates of non-diabetic mothers over a period of two years. Results: The mothers in GDM group had 66% emergency lower segment caesarean section (LSCS) compared to 32% in non- GDM group (p = 0.001). The infants of diabetic mothers (IDM) had statistically significant higher percentage of preterm births, NICU admission, hyperbilirubinemia, hypoglycaemia and polycythemia. The anthropometric and cord blood parameters (Haemoglobin, haematocrit, platelet, calcium and bilirubin) were comparable in both the groups. Conclusions: GDM poses significant risks to both mother and neonate, however optimal glycemic control and meticulous monitoring and treatment protocols can reduce the incidence of certain known complications.

Comprehensive Morphological Assessment of Cord Blood: Normal Values and the Prevalence of Morphologically Aberrant Leukocytes

Introduction: Cord blood (CB) is becoming a valuable source for stem cells utilized in a variety of cell therapy applications, as well as for newborn diagnostics. Some parameters of the CB cellular components can be provided by automated analyzers, while others, such as immature or aberrant cells, require blood film morphological assessment. The objectives of the study were to establish normal CB morphology and to determine the prevalence of morphologically aberrant leukocytes in CB. Methods: We performed a comprehensive morphological analysis of 100 CB samples taken from healthy term and appropriate-for-gestational-age neonates born to healthy mothers, preterm neonates, neonates of diabetic mothers, and small-for-gestational-age neonates. Blood counts were assessed, and manual morphological analyses were performed by laboratory specialists. Results: The manual differential count of normal CB samples established the following values: 47.8 ± 10.7% neutrophils, 31.2 ± 9.8% lymphocytes, 10.0 ± 4.0% monocytes, and 3.0 ± 2.5% eosinophils, with no significant sex-related differences. Blasts were observed in 44/100 samples with an average of 0.5 ± 0.7% per sample, and only a minor left shift was observed. There were significant populations of large granular lymphocytes (19.1 ± 10.6% of the total lymphocytes) and morphologically aberrant lymphocytes (12.4 ± 5.4% of the total lymphocytes) in the samples, irrespective of neonatal status. The differentials of preterm CB samples differ significantly from normal term CB samples, including the reverse of neutrophils/lymphocytes ratio, and the lack of basophils. Conclusions: Normal values and unique morphological features in the CB of neonates are described. The abundant morphologically aberrant lymphocytes in CB may represent an immature state of the immune system at birth.

Persistent subclinical myocardial dysfunction among infants of diabetic mothers

Persistent subclinical myocardial dysfunction among infants of diabetic mothers

Frequency of Neonatal Hypoglycemia Among Women Diagnosed with Maternal Hyperglycemia

Objective: To determine frequency of neonatal hypoglycemia, in maternal hyperglycemia Subject and Method: This cross-sectional study was conducted at department of Pathology with collaboration of gynae and OBS department of PNS SHIFA Karachi. Study duration was six months from March 2015 to August 2015. All pregnant women who reported at antenatal clinics of PNS SHIFA Hospital and diagnosed as the cases of hyperglycinemia were included in the study. Maternal blood glucose testing was done according to WHO guidelines i.e. fasting sample, ingestion of 75 g glucose, 01 h and 02 h sample for plasma glucose estimation. Neonatal blood glucose was checked immediately after birth by glucometer. All the data was collected via study proforma. Results: A total of 157 pregnant women were studied their average age was 28.20±4.67 years. Caesarean section was done in 62.4% cases and 58.6% babies were males. Neonatal hypoglycemia was observed among 24.8% of the cases. Neonatal hypoglycemia was statistically significant according to gestational age (p- 0.012), while statistically insignificant according to parity (p-0.184). Conclusion: As per study conclusion, the neonatal hypoglycemia was observed to be highly prevalent among neonates of diabetic mothers as 24.8%. It was found to be statistically significant according to gestational age. Keywords: Gestational diabetes mellitus, Neonates, Hypoglycemia

Advanced echocardiography in neonates of diabetic mothers: a large population study of newborns

Abstract Background Maternal diabetes is associated with increased risk of congenital heart defects in the newborn, but the impact on systolic and diastolic function is less well described and findings are conflicting. Purpose To assess subclinical cardiac abnormalities in newborns of diabetic mothers using advanced echocardiography. Methods Transthoracic echocardiography (TTE) was performed within 30 days after birth in unselected neonates consecutively included in a prospective, multicenter, population-based study (2016–2018 (n=25,750)). Cardiac function in newborns of mothers with pre-gestational (pre-GDM) or gestational diabetes (GDM) and a group of matched controls of newborns of non-diabetic mothers was assessed by Tissue Doppler Imaging (TDI) and Speckle Tracking Echocardiography (STE) to detect myocardial abnormalities. Controls were matched 1:1 by the following criteria; multiple pregnancy, sex, gestational age (± five days), age at TTE (± three days) and weight (± 200 g). Results TDI and STE was performed in 317 newborns exposed to maternal diabetes during pregnancy (98 newborns of mothers with pre-GDM (females; 45.7%) and 219 newborns of mothers with GDM (females; 50%)). The mean age at time of TTE in newborns of diabetic mothers was 12 days (± 7 days). Cardiac function assessed with TDI showed significantly lower mitral valve (MV) systolic annular velocity (MV S') (3.15 cm/sec ± 0.67 vs 3.41 cm/sec ± 0.68, p=0.001), MV early diastolic annular velocity (MV E') (−4.71 cm/sec ± 1.26 vs −5.07 cm/sec ± 1.10, p=0.009), MV late diastolic annular velocity (MV A') (−4.24 cm/sec ± 1.25 vs −4.67 cm/sec ± 1.34, p=0.007) and interventricular septum late diastolic velocity (IVS A') (−4.49 cm/sec ± 0.89 vs −4.84 cm/sec ± 1.01, p=0.005) in newborns of mothers with pre-GDM compared to newborns of non-diabetic mothers. Newborns of mothers with GDM showed significantly lower MV A' (−4.35 cm/sec ± 1.35 vs −4.67 cm/sec ± 1.34, p=0.008) compared to newborns of non-diabetic mothers. When comparing subtypes of diabetes, newborns of mothers with pre-GDM had significantly lower MV E' (−4.71 cm/sec ± 1.26 vs −5.02 cm/sec ± 1.22, p=0.046) and IVS A' (−4.49 cm/sec ± 0.89 vs −4.75 cm/sec ± 0.93, p=0.033) compared to newborns of mothers with GDM. STE analysis showed that end-systolic and peak longitudinal strain (LS) were significantly lower in both subtypes of diabetes when compared to newborns of non-diabetic mothers; pre-GDM: end-systolic LS −17.93% and peak LS −19.18%, GDM: end-systolic LS −18.39% and peak LS −19.56% vs −19.56% and −20.29% in children of non-diabetic mothers, p&amp;lt;0.001 for all. Standard echocardiographic parameters were similar when comparing each subtype of diabetes with the newborns of non-diabetic mothers. Conclusion Advanced echocardiography showed impaired systolic and diastolic cardiac function in newborns of diabetic mothers. The most severe impairment was seen in newborns of mothers with pre-gestational diabetes. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): PRIVATE COMPANY, Novo Nordisk Foundation: Pre-graduate Scholarhips 2019 - 6 months scholarship. Public Hospital, Herlev-Gentofte Internal Research Foundation 2019 - 6 months scholarship

Macrosomia index in neonates of diabetic mothers as a simple predictor of maternal glycemic control

Macrosomia index in neonates of diabetic mothers as a simple predictor of maternal glycemic control

Does low body fat percentage in neonates greater than the 5th percentile birthweight increase the risk of hypoglycaemia and neonatal morbidity?

Low body fat percentage (BF%) has been shown to predict morbidity and possible hypoglycaemia in newborns. Hypoglycaemia in neonates is associated with significant neonatal morbidity. Early detection and prevention are critical. To identify if low BF% (>1 standard deviation below the mean) in non-small-for-gestational-age neonates (>5th percentile body weight) increases the risk of short-term morbidity, with specific attention to hypoglycaemia. All term neonates who had their BF% measured as part of the Newborn Early Assessment Programme between 28 January 2014 and 9 August 2016 were included in the study. Neonates whose weight was below the 5th percentile and neonates of diabetic mothers were excluded as blood sugar level monitoring is routinely performed on these babies. Neonatal morbidity and blood sugar levels were obtained from electronic records, and the individual patient's paper records were reviewed. A composite score for neonatal morbidity (poor feeding AND hypothermia AND prolonged length of stay) was calculated. Statistics were analysed using SPSS. A total of 247 neonates met the inclusion criteria (3.3% of total births). Hypoglycaemia was found in 8.5% of the study population. The risk of hypoglycaemia did not change significantly in neonates with birthweight of the 5th-10th percentile and >10th percentile (8 vs. 8.8%); 4.9% of babies met the combined morbidity criteria. Non-small-for-gestational-age babies (>5th percentile) with low BF% are at risk of hypoglycaemia and short-term morbidity. These infants will not be identified by current hypoglycaemia screening methods in centres that do not measure BF%.