Newborn Infants Of Diabetic Mothers Research Articles

Brain and behavioural maturation in newborn infants of diabetic mothers. 3. Motor behaviour.

See also: Brain and Behavioural Maturation in Newborn Infants of Diabetic Mothers1– Part II: Sleep cycles2Neuropediatrics 1969; 1(01): 36-43DOI: 10.1055/s-0028-1091862

Brain and behavioural maturation in newborn infants of diabetic mothers. II. Sleep cycles.

Brain and behavioural maturation in newborn infants of diabetic mothers. II. Sleep cycles.

Brain and behavioural maturation in newborn infants of diabetic mothers. I. Nerve conduction and EEG patterns.

See also:Brain and Behavioural Maturation in Newborn Infants of Diabetic Mothers1– Part II: Sleep cycles2Neuropediatrics 1969; 1(01): 36-43DOI: 10.1055/s-0028-1091862

THE RESPONSE OF INFANTS OF DIABETIC WOMEN TO TOLBUTAMIDE AND LEUCINE AT BIRTH, AND TO GLUCOSE AND TOLBUTAMIDE AT 2 YEARS OF AGE

Twelve newborn infants, 2 to 8 days old, of gestational (IGDM) and insulin-requiring (IDM) diabetic mothers responded to intravenous tolbutamide (20 mg/kg) with abnormally large decreases in plasma glucose and marked rises in plasma insulin (the latter was measured only in IGDM). Only 3 of 13 IGDM tested with leucine had significant decreases in plasma glucose. Newborn infants of normal mothers showed no changes in glucose or insulin in response to intravenous tolbutamide, and one of five had a small decrease in glucose levels after leucine. The results suggest the presence of large stores of pancreatic insulin in newborn infants of diabetic mothers which are more readily released by stimulation with tolbutamide than with leucine. The offspring of the diabetic women were restudied at 2 years of age for their response to intravenous tolbutamide and oral glucose. Seven of nine children had normal glucose and insulin levels after intravenous tolbutamide, and two had abnormally low glucose levels with high insulin levels. Three of the nine had normal glucose tolerance with normal insulin levels. The other six had abnormally elevated glucose levels which varied in duration from one-half to 2 hours. Four of the six had an accompanying hyperinsulinemia; two, who had diabetic glucose tolerance, had poor insulin responses. The findings in the 2-year-old children support a concept that the fetal environment provided by a diabetic woman has effects on carbohydrate tolerance which extend beyond the newborn period.

Acid-base and electrolyte balance in newborn infants of diabetic mothers.

SummaryThe acid‐base and electrolyte balance was studied in 8 diabetic and 8 healthy mothers and their infants at caesarean section near term.Microliter methods were used for determination of pH, total CO2, potassium, sodium, chloride, calcium, total protein, inorganic phosphorus, glucose and lactate.The acid‐base and electrolyte balance of the newborn infant of a well‐controlled diabetic mother did not differ significantly from that of a newborn infant of a healthy mother.The infant of a diabetic mother seemed to be able to correct for an excess load of glucose and to maintain a “normal” level in the blood in the umbilical artery.Earlier observations that intense maternal hyperventilation is associated with a changed uterine and placental circulation and results in fetal acidosis were not confirmed in the present study.

URINARY CATECHOLAMINE EXCRETION IN INFANTS OF DIABETIC MOTHERS

A transient, often profound, hypoglycemia is usually found in newborn infants of diabetic mothers. Normally, hypoglycemia results in large increases in urinary catecholamines, mainly as the adrenaline fraction. Multiple excretion rate studies were carried out in 21 infants of diabetic mothers in hypo ("low") and normoglycemic ("high") periods assigned on the basis of blood sugars below or above 40 mg/100 ml. Mean level was 25 mg/100 ml (range, 7 to 39) for the "low" and 72 mg/100 ml (range, 45 to 133) for the "high" periods. Mean urinary catecholamines were for adrenaline, 0.030 ± 0.006 nanograms(ng)/kg/minute in the "high" and 0.029 ± 0.009 ng/kg/minute in the "low" periods. For noradrenaline the comparable values were 0.388 ± 0.060 ng/kg/minute falling to 0.281 ± 0.044 ng/kg/minute. In 16 of the 21 infants comparative studies were available for each infant in both periods. Analyzed as the differences between pairs, there was no change in adrenaline but a highly significant (p < 0.001) decline in noradrenaline following hypoglycemia. In addition to the failure of the anticipated hypoglycemic increase, the resting (normoglycemic) levels for both fractions were extremely low compared to two groups of normal infants within the first 24 hours, as well as the first week, of life. These findings are suggestive of an adrenal medullary exhaustion phenomenon consistent with the view that the hypoglycemia is of long standing (intra-uterine) duration. The seemingly inappropriate noradrenaline depletion is likely a reflection of the different composition of the neonatal as opposed to the adult gland.

Hemopexin in newborn infants of diabetic mothers.

Serum proteins from cord blood of 27 infants of diabetic and 16 infants of normal women of comparable gestational age (38–39 weeks) were studied by immunoelectrophoresis. In accord with our previous finding of elevated serum glycoprotein levels in newborn infants of diabetic mothers, a well-defined precipitation arc in the beta-one globulin region, inside the concavity of the transferrin arc, was identified in these infants as hemopexin, because it (a) stained intensively for carbohydrate, (b) did not bind hemoglobin but did bind hemin, and (c) formed a single benzidine-positive line with anti-hemopexin serum.

The effect of endogenous antibody on insulin-assay in the newborn infants of diabetic mothers.

Extract: The immunoassay of insulin in blood of infants born to diabetic mothers is complicated by the presence of anti-insulin antibodies. Twelve infants born to diabetic mothers receiving insulin up to the time of delivery (Group 1) and two born to diabetic mothers maintained by dietary restrictions without insulin (Group 2) were studied. Four infants born to normal mothers served as controls (Group 3). The range of values in cord blood of infants of Group 1 was 80-1000 (median 550) (method of HALES and RANDLE) and 33 to 72.5 % (median 53.8) ofthe radioactivity was bound to plasma proteins. In one infant in Group 1, maximum amount of the radioactivity (42.3 %) from labeled insulin (43 %) was bound to a γ-globulin (0% in Groups 2 and 3). In one infant in Groups 2 and 3 maximum amount of radioactivity was in the α-globulin fraction (44.1 and 35.3 % respectively). At 120 minutes after birth, glucose, 0.5 gm/kg body weight, was infused quickly into the umbilical vein of 6 patients in Group 1 and the two in Group 2. In the former, insulin levels rose significantly, 1- to 4-fold, despite the elevated level at commencement of infusion; in the latter, the insulin levels rose 4-fold in one case and 18-fold in the second. The amount of anti-insulin antibody present in serum of infants in Group 1 did not change significantly during the first 240 minutes after birth; neither was it affected by the administration of glucose and the subsequent appearance of endogenous insulin. Speculation: Although the infant born to a diabetic mother has elevated levels of insulin and circulating anti-insulin antibodies, his ability to release insulin following a glucose challenge appears unimpaired. This combination of abnormalities suggests an alteration in glucose homeostasis, but fails to explain the hypoglycemia commonly seen in such infants, unless the anti-insulin antibodies do not interfere with the hypoglycemic effects of insulin.

Pancreatic Insulin Content in Severe Erythroblastosis Fetalis

The pancreatic insulin content of 16 infants with lethal erythroblastosis fetalis was determined and compared with 17 controls of similar gestational ages. Significantly higher insulin levels, comparable to those exhibited by newborn infants of diabetic mothers, were found in the babies with hemolytic disease of the newborn.

II. Own investigation: Cortisol production rate in normal full‐term newborn infants and newborn infants of diabetic mothers as determined by the isotope dilution principle

SummaryThe literature on the adrenocortical function in the early neonatal period is reviewed. The results of recent studies in this field are inconsistent with the assumption of a relative adrenocortical hypofunction in the neonate, formerly inferred from the earlier findings of low plasma levels of 17‐hydroxycorticosteroids and low urinary excretion of 17‐hydroxycorticosteroids in this period of life. It seems possible, however, that there is a relative depression of the adrenocortical function during the 12th to 36th hour of life as reflected by decreased plasma levels of 17‐hydroxycorticosteroids and diminished response to ACTH stimulation in this period; but, on the whole, the adrenal cortex in the newborn infant seems as active in relation to body surface area as in older age groups. The available data on the newborn infants of diabetic mothers hardly permit any conclusion as to their neonatal adrenocortical function in comparison with normal newborns.By means of an isotope dilution method cortisol production per 24 hours was studied between the 3rd and 6th day of life in 5 normal full‐term infants and 8 infants born to diabetic mothers. The validity of the method rests on certain assumptions which are discussed with special reference to its use in newborn infants. A comparison of the specific activities of different cortisol metabolites indicates not only that the method satisfies validity requirements, but that it has a reasonable degree of specificity and precision.The mean value for cortisol production per 24 hours in the normal infants was 4.7 mg, ranging from 3.5 to 6.1 mg. In the infants of diabetic mothers the mean value was 5.5 mg, ranging from 3.1 to 7.3 mg. There was no significant difference between these mean values. When corrected for body surface area the cortisol production per ma body surface ranged from 19.4 to 26.4 mgm2, with an average of 22 mg/m2 in normal infants, and from 13.8 to 37.8 mg/m2, with an average of 26.9 mg/m2, in the infants of diabetic mothers. There was no significant difference between the mean values. There was no obvious correlation between the cortisol production rates and the severity of maternal diabetes or the infants' appearance at birth. It seems probable that the new‐born infant produces more cortisol in relation to body surface area than the adult. When the production rates were expressed in terms of mg/m2 body surface area, there seemed to be a tendency towards higher values with decreasing gestational age. These findings are interpreted as a reflection of the increasing demands on the adrenal cortex during adaptation to extrauterine life.

II. Own investigation: Studies on the metabolism of 4‐C14‐cortisol in newborn infants

II. Own investigation: Studies on the metabolism of 4‐C¹⁴‐cortisol in newborn infants

CHAPTER V: Pathogenetic aspects of some of the characteristic features in newborn infants of diabetic mothers

CHAPTER V: Pathogenetic aspects of some of the characteristic features in newborn infants of diabetic mothers

Cortisol production rate in newborn infants of diabetic mothers

The cortisol production rate was determined in 5 normal infants and in 8 infants born to diabetic mothers. Despite the resemblance of progeny of diabetic mothers to persons with Cushing's syndrome, these studies showed no significant difference in the rate of cortisol production between the two groups. It would appear that on the basis of surface area the cortisol production of infants is greater than that of adults.

Immuno-electorphoretic demonstration of differences in serum proteins of newborn infants of normal and diabetic mothers.

IN a previous communication we reported that newborn infants of diabetic mothers have raised serum glycoprotein-levels when compared with infants of normal mothers of similar gestational age1. In continuation of this investigation we have subjected the same sera to immuno-electrophoresis in agar gel, using a modification of Scheidegger's micro-method2. Commercially available anti-sera from the Pasteur Institute were used as a mixture from horses No. 223 and No. 224.

Body Composition of Newborn Infants of Diabetic Mothers, Mogens Osler, Copenhagen F, Denmark, Osler, 1961, 79 pp

Dr. Osler, in his monograph, merely reiterates and summarizes work he has done in studying the height, weight, urinary excretion, and compartmental body water in babies of diabetic mothers. In the monograph, he presents the data in a fashion that makes it impossible to analyze and has added nothing new except that the diabetic baby is the proper length for its weight. In addition, he has made a sketchy, uncritical review of the literature pertaining to these babies and presents the data, again, in a summary fashion.

Serum Glycoproteins in Newborn Infants of Diabetic Mothers

Serum Glycoproteins in Newborn Infants of Diabetic Mothers

THE BODY COMPOSITION OF NEWBORN INFANTS OF DIABETIC MOTHERS

Studies on the body composition of new born infants of diabetic mothers (diabetic infants) are reported. Birth weight and length, total body water, water compartments, body fat, osseous maturity, and urinary excretion of water, electrolytes and nitrogen were determined in newborn infants of diabetic mothers, and for comparison in normal full-term infants (normal infants) and new-born infants of the same gestational age as the first group, but born to nondiabetic mothers (control infants). Infants of diabetic mothers must be characterized as infants whose maturity in terms of development of ossification centers, excretion of water, electrolytes and nitrogen, and other organ functions corresponds to their chronologic age, or even less. Besides they are grossly overweight on account of a surplus of fat, and to a lesser degree, of carbohydrate stores in tissues and organs. The combination of premature organ functions, increased fat content and water release on account of breakdown of protein and carbohydrate stores after birth, may be major factors in the neonatal pulmonary syndrome exhibited by infants of diabetic mothers. Discussing the influence of glucose plus insulin, growth hormone and adrenal cortical steroids upon the body composition, the authors conclude that the changes found in newborn infants of diabetic mothers may be due primarily to maternal hyperglycemia.

Body water of newborn infants of diabetic mothers.

ABSTRACT The total body water as well as the distribution of water in the extracellular and intracellular compartments was determined in 23 infants born to diabetic mothers (diab. infants) and 15 infants born to normal mothers (normal infants). The total body water was determined by the dilution method using heavy water, and the extracellular water by the dilution method using thiosulphate. Intracellular water was calculated as total water less extracellular water. The analytical methods are described. Diab. infants proved to have a mean total body water of 2.48 litres or 70.2 per cent of the body weight, a mean extracellular water content of 1.41 litre or 38.5 per cent of the body weight, and a mean intracellular water content of 1.16 litre or 31.8 per cent of the body weight. Normal infants had a mean total body water of 2.58 litres or 78.2 per cent of the body weight, a mean extracellular water content of 1.53 litre or 44.9 per cent of the body weight, and a mean intracellular water content of 1.12 litre or 33.5 per cent of the body weight. The reduction in total and extracellular water in the diab. infants is statistically significant, whereas that of intracellular water is more doubtful. The reduction in total body water means that diab. infants are obese. A marked decrease in total as well as extracellular water without a substantial decrease in intracellular water cannot be due to obesity alone, since fat is assumed to contain more extracellular than intracellular water. Increased deposition of glycogen, which binds water in the cells and constitutes an intermediate product in the transformation of glucose to fat, can explain, when also considering the obesity, the reduction in total and extracellular water without a simultaneous decrease of intracellular water. Considering the influence of insulin, corticosteroids and growth hormone on the body composition, the author concludes that the changes found in the body composition of newborn infants of diabetic mothers (obesity + presumably increased glycogen) may be assumed to be due to maternal hyperglycaemia with consequent foetal hyperglycaemia + hyperinsulinism, but not to an action of maternal growth hormone. In other words, the result supports the so-called hyperglycaemia hypothesis as the cause of the increased weight and changed body composition of the newborn infants of diabetic women.

Body fat of newborn infants of diabetic mothers.

ABSTRACT The body fat of newborn infants of diabetic mothers (diab. infants), normal full-term infants (norm, infants), and control infants, i. e. infants of the same gestational age as the diab. infants but born to normal mothers was determined by anthropometric measurements of the subcutaneous fat, partly by using a skin-fold caliper and partly by measuring the layer of subcutaneous tissue on X-ray films of the lower leg and chest. The thickness of the subcutaneous layer of fat was found to be increased in diab. infants by 38–46 % as compared with normal infants and by 50 % as compared with the control infants. In this connection, the author refers to his previous studies of total body water in diab. infants and normal infants, since the fat content may be estimated on the basis of a knowledge of total body water. These studies showed that the total body water of diab. infants is 10 per cent below that of normal infants. The techniques used cannot accurately determine the absolute fat content in the body, but it is illustrated by an example that the overweight of 550 g in diab. infants compared with normal control infants may be explained by an increased fat and glycogen content. Glycogen is formed in various quantities in the course of the transformation of carbohydrate into fat and is deposited, with binding of water, in the intracellular compartment. From the investigations it may be concluded that at birth diab. infants are obese and thus have a relatively low total body water. The obesity may increase the resistance to respiration and strain the cardiovascular system. The apparent paradox that despite a low body water diab. infants show a tendency to oedema, large urinary output, and marked weight loss after birth may be explained by the phenomenon that apart from being obese. they contain various quantities of glycogen which binds water in the intracellular compartment. After birth, a rapid breakdown of glycogen occurs, involving a release of water, and this results in a tendency to oedema, large urinary output, and subsequent weight loss due to the excretion of water.

Water and electrolyte economy in newborn infants of diabetic mothers.

Acta PaediatricaVolume 49, Issue 2 p. 121-128 Water and Electrolyte Economy in Newborn Infants of Diabetic Mothers CHARLES D. COOK, CHARLES D. COOK *Children's and Boston Lying-in Hospitals and the Department of Pediatrics Harvard Medical School, BostonSearch for more papers by this authorDONOUGH O'BRIEN, DONOUGH O'BRIEN Grocer's Company Research ScholarSearch for more papers by this authorJOHN D. L. HANSEN, JOHN D. L. HANSEN Cecil John Adams Memorial Travelling Fel-low.Search for more papers by this authorMARC BEEM, MARC BEEM *Children's and Boston Lying-in Hospitals and the Department of Pediatrics Harvard Medical School, BostonSearch for more papers by this authorCLEMENT A. SMITH, CLEMENT A. SMITH *Children's and Boston Lying-in Hospitals and the Department of Pediatrics Harvard Medical School, BostonSearch for more papers by this author CHARLES D. COOK, CHARLES D. COOK *Children's and Boston Lying-in Hospitals and the Department of Pediatrics Harvard Medical School, BostonSearch for more papers by this authorDONOUGH O'BRIEN, DONOUGH O'BRIEN Grocer's Company Research ScholarSearch for more papers by this authorJOHN D. L. HANSEN, JOHN D. L. HANSEN Cecil John Adams Memorial Travelling Fel-low.Search for more papers by this authorMARC BEEM, MARC BEEM *Children's and Boston Lying-in Hospitals and the Department of Pediatrics Harvard Medical School, BostonSearch for more papers by this authorCLEMENT A. SMITH, CLEMENT A. SMITH *Children's and Boston Lying-in Hospitals and the Department of Pediatrics Harvard Medical School, BostonSearch for more papers by this author First published: March 1960 https://doi.org/10.1111/j.1651-2227.1960.tb07713.xCitations: 5 AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume49, Issue2March 1960Pages 121-128 RelatedInformation