Kaan DEMİRÖREN, Hasan KOÇ, H. Ali YÜKSEKKAYA

Diabetik anne bebeğinde komplikasyonlar

Amaç: Diabetik anne bebeklerini metabolik, kardiyak, doğum travması ve diğer komplikasyonları açısından incelemeyi amaçladık. Yöntem: Yenidoğan yoğun bakım ünitesinde Eylül 1998-Mart 2001 tarihleri arasında yatırılarak izlenen 46 diabetik anne bebeğini retrospektif olarak inceledik. Bulgular: Bebeklerin 24'ü (% 52.2) kız, 22'si (% 47.8) erkekti. Gestasyon yaşına göre vücut ağırlığı 38 (% 82.6) hastada 90 persentilin üzerindeydi. Asfiksi bulguları 13 (% 28.2) hastada değişik derecelerde mevcuttu. Zor doğuma ait travmàtik yaralanma bulguları 7 (% 15.2) hastada tespit edildi. Respiratuar distres sendromu 5 (% 10.9) hastada gelişti. Hipoglisemi 17 (% 37.0) hastada, fototerapi gerektirecek düzeyde hiperbilirubinemi 15 (% 32.6) hastada, hipokalsemi 3 (% 6.5) hastada, polisitemi 5 (% 10,9) hastada mevcuttu. Hastaların 22'sinde (% 47.8) ekokardiyografi ile anormal kardiyak bulgular saptandı. Mortalité oranı % 4.3 (2 hasta) idi. Sonuç: Gebelerin yakından takip edilerek kan şekerlerinin uygun düzeylerde tutulması, annelere diabetin bebekler üzerindeki sonuçları hakkında bilgi verilmesi, doğum ve sonrası için uygun koşulların hazırlanması diabetik anne bebeklerinde périnatal mortalité ve morbidité hızlarını azaltacaktır.

Anahtar Kelimeler:

Gebelikte diabet, Geriyedönük çalışma, Gebelik yaşı, Doğum yaralanmaları, Fetal makrosomi, Kalp damar anomalileri, Süt çocuğu, yenidoğan, hastalıklar, Solunum güçlüğü sendromu, yenidoğan

Complications in infant of diabetic mother

Objective: We aimed to investigate infant of diabetic mother about metabolic, cardiac, birth injuries and the other complications. Methods: We investigated 46 infants of diabetic mothers, hospitalized in our neonatal care unit, from September 1998 to March 2001, retrospectively. Results: Twenty four (52.2%) of the infants were female, and 22 (47.8%) of them were male. Birth weights according to gestational ages were above the 90th percentile in 38 (82.6%) patients. Various degrees of asphyxia findings were present in 13 (28.2%) patients. Delivery related traumatic injuries were detected in 7 (15.2%) patients. Respiratory distress syndrome developed in 5 (10.9%) patients. Seventeen (37.0%) patients had hypoglycemia, 15 (32.6%) had hyperbilirubinemia requiring phototherapy, 3 (6.5%) had hypocalcemia and 5 (10.9%) had polycytemia. Echocardiographic findings of cardiac abnormalities were determined in 22 (47.8%) patients. Mortality rate was 4.3% (2 patients). Conclusion: Achieving appropriate prenatal blood glucose levels, informing the mothers about the morbid effects of diabetes on the'r babies, preparing the suitable environmental conditions for delivery and postnatal care would reduce the perinatal mortality and morbidity rates of infants of diabetic mothers.

Keywords:

Pregnancy in Diabetes, Retrospective Studies, Gestational Age, Birth Injuries, Fetal Macrosomia, Cardiovascular Abnormalities, Infant, Newborn, Diseases, Respiratory Distress Syndrome, Newborn,

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1. Tyrala EE. The infant of the diabetic mother. Obstet Gynecol Clin North Am 1996;23:221-41.
2. Dağoğlu T. Diabetik anne çocuğu. İçinde: Dağoğlu T, editör. Neonatoloji. İstanbul: Nobel; 2000. p:651-6.
3. Gomella TL, Cunningham D, Eyal FG. Neonatology, 3rd edition. USA: Appleton&Lange; 1994.
4. Can G, Çoban A, İnce Z. Yenidoğan ve hastalıkları. İçinde: Neyzi O, Ertuğrul T, editörler. Pediatri, 3. Baskı. İstanbul: Nobel; 2002. p.295-444.
5. Sarnat HB, Sarnat MS. Neonatal encephalopathy following fetal distress. A clinical and electroencephalographic study. Arch Neurol 1976;33:696-705.
6. Kalkhoff RK. Impact of maternal fuels and nutritional state on fetal growth. Diabetes 1991:40(suppl 2):61-5.
7. Coustan DR, Imarah J. Prophylactic insulin treatment of gestational diabetes reduces the incidence of macrosomia, operative delivery and birth trauma. Am J Obstet Gynecol 1984;150:836-42.
8. Conway DL, Langer O. Elective delivery of infants with macrosomia in diabetic women: reduced shoulder dystocia versus increased cesarean deliveries. Am J Obstet Gynecol 1998;178:922-5.
9. Green DW, Khoury J, Mimouni F. Neonatal hematocrit and maternal glycemic control in insulin-dependent diabetes. J Pediatr 1992;120(2 Pt 1):302-5.
10. Miller E, Hare JW, Cloherty JP, Dunn PJ, Gleason RE, Soeldner JS, et al. Elevated maternal hemoglobin A1C in early pregnancy and major congenital anomalies in infants of diabetic mothers. N Engl J Med 1981;304:1331-4.
11. Ylinen K, Aula P, Stenman UH, Kesaniemi-Kuokkanen T, Teramo K. Risk of minor and major malformations in diabetes with haemoglobin A1C values in early pregnancy. BMJ 1984;289:345-6.
12. Thorsson AV, Hintz RL. Insulin receptors in the newborn, increase in receptor affinity and number. N Engl J Med 1977;297:908-12.
13. Oberhoffer R, Hogel J, Stoz F, Kohne E, Lang D. Cardiac and extracardiac complications in infants of diabetic mothers and their relation to parameters of carbohydrate metabolism. Eur J Pediatr 1997;156:262-5.
14. Jordan GI, Quintilla MJM, Alcover BE, Gonzalez LG, Rodriguez-Miguelez JM, Figueras AJ. Morbidity of the newborn infant born to a diabetic mother in relation to macrosomia. An Esp Pediatr 1999;50:275-8.