Neonatal Hypoglycemia: Review of practice

The audit was to measure compliance to the Arrowe Park neonatal unit hypoglycaemia guideline which was adopted in 2017. The guideline reflected lowering the blood sugar threshold from 2.6 to 2.0mmol/litre in neonates from 34weeks to 42weeks gestation age. The study looked into the incidence of hypoglycaemia in babies with suspected sepsis and perinatal acidosis.METHODSThis was a retrospective audit of babies at risk of hypoglycaemia on the postnatal ward.58 babies between 34weeks to 42weeks gestation age recruited from 1/2/2019 to 28/02/2019. The indications are- Prematurity- 34-36weeks (10), Infant of diabetic mother (4), Infant of the mother with gestational diabetes (6), Infant of mother on B-blockers (5). Others are suspected sepsis (11), and perinatal asphyxia/acidosis (11). Proforma generated based on British Association of perinatal medicine (BAPM) guideline on management of hypoglycaemia.RESULTS1 out of 10 babies born at gestation age 34-37weeks and 1 out of 5 babies of born to diabetic mother had blood glucose 2, 0- They are asymptomatic.2 out of 11 babies with suspected sepsis had blood glucose <2. The 2 babies had a negative blood culture and C-reactive protein.2134 The 8th Congress of the European Academy of Paediatric Societies - EAPS 2020Poster PresentationCONCLUSIONThe effect of dropping the blood sugar threshold from 2,6- 2mmmol/l is safe for this study and no record of neonate symptomatic at blood glucose of 2,0-2,6mmol/l. Risk of neonatal hypoglycaemia in neonates with suspected sepsis and cord Ph<7, 1 has not been noted in this audit. This study needs to be carried out with large sample size and possible multiple centres.

Multiple thromboses in a late preterm infant present at birth

A late preterm infant was born to a diabetic mother on a background of reduced fetal movements and a poor CTG. It was noted immediately at birth that there was pathology in both upper limbs. Targeted investigation led to the diagnosis of bilateral upper limb arterial thromboses. Prompt assessment and multidisciplinary discussion led to an individualised management plan resulting in a positive outcome.

Leukocyte profile in cord blood of newborns to diabetic and non-diabetic mothers

Background: Increasing incidence of diabetes due to strees inducing life-style, involves dearrangement of carbohydrate, fat, protein metabolism characterized by hyperglycemia, hyperlipidimia and negative nitrogen balance respectively. Causing morbidity and mortality, effects gestational diabetes. Pregnancy, capacity to secrete insulin increases with gestational age, has effect in last trimester of pregnancy. Maternal glycemic-status influences neonates leucocyte profile.Methods: Fully automated haematology analyzer ABXMICROsot used to analyze cord blood of neonates born to 40 diabetic (known to be diabetic at pregnancy) and 40 non-diabetic mothers, collected in EDTA tubes. Diabetic group was sub divided into D1 and D2. D1 as 100-150 mg/dcl, D2 as above 150 mg/dcl. Statistical treatment of Levene's test of equality of variances applied to the data.Results: WBC count, granulocyte percent and monocyte percent were significantly lower, lymphocyte percent was higher in neonates to diabetic mothers. Significantly higher in D2 then D1group. The prognosis for the child of a pregnant diabetic is related to the degree of control of mother’s glycemic status, reflected higher indices in D2 then D1.Conclusions: Neonates immune system depends on the mother's immune system i.e.; immunological properties are practically under control of interleukin-1 and interleukin-6. Interleukin-6 potentiates action of interleukin-1 synergistically, such action of interleukin converts non-committed stem cells to committed stem cells. Immunosuppressant status in diabetic mother (i.e.; non-priming of neonatal interleukin-6 by immunosuppressant diabetic mother’s interleukin-6, main cause for altered counts) modulating neonatal interleukin-6 it decreases haematopoietic potential in the neonates, ECF in infants of diabetic mother is reduced leading to haemo-concentration, increasing cell count. Pictures as increase cell count at birth in neonates of diabetic mother.

Erythrocyte profile in cordblood of newborns to diabetic and non-diabetic mothers

Background: Diabetes, an endocrinal disorder causing morbidity and mortality has its effect on gestational diabetes. Intrapartum stress, maternal hyperglycemia leads to fetal hyperglycemia. The maternal glycaemic status has influence on neonates erythrocyte profile.Methods: Cord blood of neonates born to 40 diabetic (known to be diabetic at pregnancy) and 40 non-diabetic mothers were selected. A fully automated hematology analyzer ABXMICROsot was used to analyze whole blood collected in EDTA tubes. The diabetic group was subdivided into D1 and D2. D1 as 100-150 mg/dcl, D2 as above 150 mg/dcl.Results: Hemoglobin, hematocrit, MCV, MCH, RDW were significantly higher, RBC count were comparatively insignificant. Hemoglobin (Hb), hematocrit (HCT), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), Mean corpuscular hemoglobin concentration (MCHC) were significantly higher in D2 than D1 group. The prognosis for the child of a pregnant diabetic is related to the degree of control of mother’s glycemic status, reflected as higher indices in D2 than D1.Conclusions: Neonatal immune system depends on maternal immune system i.e, all the immunological properties are practically under the control of interleukin-1 and interleukin-6. Interleukin-6 potentiates the action of interleukin-1 synergistically, such action of interleukin converts noncommitted stem cells to committed stem cells. Immunosuppressant status in diabetic mother (i.e., non-priming of neonatal interleukin-6 by immunosuppressant diabetic mother`s interleukin-6, the main cause for these altered count). By modulating neonatal interleukin-6 it decreases hematopoietic potential in the neonates, on the other hand ECF in infants of diabetic mother is reduced leading to hemoconcentration and increase in cell counts. Giving a picture as if polycythemia at birth in neonates of diabetic mothers.

Risk Factors and Causes of Neonatal Hyperbilirubinemia: A Systematic Review Study

Context: Jaundice is a common problem and the most common risk factor for hospitalization during the neonatal period. Objective: The prevention of neonatal hyperbilirubinemia would not be possible without identifying its predisposing risk factors. The present systematic review study aims to determine the risk factors of neonatal jaundice. Data Sources: Databases including Science Direct, Cochrane Library, Web of Science (ISI), PubMed, and Google Scholar were searched to identify all eligible papers concerning the risk factors of neonatal hyperbilirubinemia. Study Selection: This systematic review was performed to review the causes and risk factors of neonatal hyperbilirubinemia. Finally, 18 articles were defined as eligible for further review. Data Extraction: The keywords included neonates, jaundice, hyperbilirubinemia, and risk factors. The inclusion criteria were studies determining jaundice risk factors, while papers with only published abstracts were excluded. Results: A total of 18 eligible articles (3 retrospective, 4 prospective, 10 cross-sectional, and 1 historical cohort) out of 421 retrieved articles were included in this review. The etiologic causes for neonatal jaundice were ABO incompatibility (24.6%), infection (including UTI and sepsis) (13.7%), G6PD deficiency (9.4%), Rh incompatibility (7%), and cephalohematoma (2.9%), while, known predisposing factors for neonatal jaundice included unknown (33.2%), low birth weight (30.9%), hyperbilirubinemia in siblings (22.7%), prematurity (20.1%), and infant of diabetic mother (6.7%). Conclusion: According to our review with considering the studies, the etiologic causes for neonatal jaundice are ABO incompatibility, infection (including UTI and sepsis), G6PD deficiency, Rh incompatibility, and cephalohematoma. While, known predisposing factors for neonatal jaundice include low birth weight, hyperbilirubinemia in siblings, prematurity, and infant of diabetic mother.

Neonatal Hypocalcemia in the Infant of a Diabetic Mother

Neonatal hypocalcemia (NHC) is one of the most common disorders of calcium metabolism in infants admitted to the NICU. Presentation can range from asymptomatic to generalized seizures or tetany. In this case study, an infant with NHC is presented along with an overview of the pathophysiology, prevalence, diagnosis, and management of NHC for neonatal clinicians.

Congenital heart defects in neonates born to diabetic mother (IDM): A single center experience.

Neonates born to diabetic mothers babies are more prone to develop congenital anomalies and defects. Overall risk of development of congenital malformations increases by 2-12% compared to normal neonates. In Pakistan, the true prevalence of CHD is unknown. Objectives: To determine the frequency of congenital heart diseases in infants born to diabetic mothers (IDM). Study Design: Cross Sectional Study. Setting: Pediatric Ward, Emergency and OPD, Allied Hospital, Faisalabad. Period: Six month after the approval of synopsis, August 16, 2017 to February 16, 2018. Material & Methods: Total 295 neonates born to diabetic mothers diagnosed presenting in neonatal unit were enrolled in study. Chest X-ray, electrocardiography (ECG) and echocardiography were done to identify CHDs. Results: Total 292 infants born to diabetic mother were selected. Mean age of the patients was 10.1±5.9 days. Of total, 189 (64.7%) were males and 103 (35.3%) were females. Out of 292 infants of diabetic mothers, 138(47.3%) were having various (CHD) and remaining 48(47.5%) were found normal after echocardiography. Conclusion: The cardiovascular system along with other systems of the body of neonates is affected in about 50% of the neonates born to diabetic mothers. Early diagnosis of CHD using a screening echocardiography is recommended to morbidity and mortality.