PLACENTAL TRANSFUSION IN INFANTS OF DIABETIC MOTHERS ELUCIDATED BY PLACENTAL RESIDUAL BLOOD VOLUME

The influence of the method of delivery and the clamping technique on the placental transfusion is investigated by measurement of the placental residual blood volume in 58 infants of diabetic mothers and in 65 infants of nondiabetic mothers. It is shown that infants of diabetic mothers delivered vaginally compared with infants of diabetic mothers delivered by caesarean section, have a larger placental residual blood volume, if early clamping is employed. This relation suggests that also in infants of diabetic mothers, a temporary deposition of the distribution of the foeto-placental blood volume between the infant and the placenta occurs during vaginal delivery, because of the impaired venous backflow to the infant. The difference in the placental residual blood volume is more pronounced for infants of diabetic mothers than for infants of non-diabetic mothers. Further, it is shown that the placental residual blood volume is significant larger in infants of diabetic mothers but only after vaginal delivery with early clamping, compared with the same group of infants of non-diabetic mothers.     

ACID-BASE AND ELECTROLYTE BALANCE IN NEWBORN INFANTS OF DIABETIC MOTHERS

The 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.     

THE TRANSCAPILLARY ESCAPE RATE OF T-1824 IN NEWBORN INFANTS OF DIABETIC MOTHERS AND NEWBORN INFANTS WITH RESPIRATORY DISTRESS OR BIRTH ASPHYXIA

ABSTRACT. Ingomar, C. Joh. and Klebe, J. G. (Diabetes Center of the Royal Maternity Hospital and the University Department for Newborn Infants, Rigshospitalet, Copenhagen, Denmark). The transcapillary escape rate of T-1824 in newborn infants of diabetic mothers and newborn infants with respiratory distress or birth asphyxia. Acta Paediatr Scand, 63: 565, 1974.—The influence of certain clinical conditions (idiopathic respiratory distress, birth asphyxia and diabetic embryopathy) on the transcapillary escape rate of human albumin, was investigated in 52 newborn infants. The dyestuff T-1824 (Evan's blue) was used for the labelling of plasma albumin in vivo, and its plasma concentration was determined spectrophotometrically using a micro-method. From serial measurements carried out during the first hour following the injection of T-1824, the escape rate (%/hour) was calculated. Among healthy newborn infants the escape rate was found to increase proportional to the magnitude of the placental transfusion. The same applied to infants with respiratory distress and infants of diabetic mothers, the escape rate of whom did not differ from that of healthy infants. By contrast, the escape rate of albumin was, among some cases of birth asphyxia, found to be increased out of proportion to the placental transfusion, which the infants had received. It is discussed whether the increased escape rate found in these cases is caused by an increased capillary permeability or an increased capillary surface area.     

EFFECT OF GLUCAGON ON BLOOD GLUCOSE HOMEOSTASIS IN INFANTS OF DIABETIC MOTHERS

ABSTRACT: Wu, P. Y. K., Modanlou, H. and Karelitz, M. (Department of Pediatrics, University of Southern California School of Medicine, Los Angeles County-University of Southern California Medical Center, Los Angeles, USA). Effect of glucagon on blood glucose homeostasis in infants of diabetic mothers. Acta Paediatr Scand, 64:441, 1975.–Thirty infants of diabetic mothers (IDM) were randomly selected and divided into 3 groups of 10 babies each. Group A were used as controls. Group B received glucagon 300Uµg/kg i.m. and Group C received glucagon 300µg/kg i.v. at birth. Hypoglycemia developed in 6 infants in Group A and 4 infants in Group B. None of the infants in Group C had hypoglycemia. Mean blood glucose was higher in Group C in the first 3 hours than Group A, and higher in Group B in the first 1/2-1 hour. I.v. glucagon, 300µg/kg when given in the first IS minutes after birth prevented hypoglycemia in IDM in the first hours of life.     

PLASMA NORADRENALINE AND ADRENALINE IN INFANTS OF DIABETIC MOTHERS AT BIRTH AND AT TWO HOURS OF AGE

ABSTRACT. Plasma noradrenaline and adrenaline in the umbllical artery were very high in many infants of both diabetic mothers (IDM) and non-diabetic mothers (controls) compared to values obtained in adults. Blood pH was slightly but significantly lower in IDM than in controls at delivery. There was a significant negative correlation between plasma noradrenaline and blood pH in IDM at birth, but no correlation between plasma noradrenaline and blood glucose, birth weight and Apgar scores. Plasma noradrenaline decreased significantly from birth to two hours of age both in IDM and controls. At two hours of age plasma noradrenaline and adrenaline were significantly greater in IDM compared to controls whereas blood glucose concentration was lower in the former group. There was a close inverse correlation between plasma noradrenaline and adrenaline, respectively, and blood glucose in IDM at two hours of age but not in controls. The elevated plasma noradrenaline at delivery in IDM may be explained by clinically undetectable acidosis whereas elevated plasma catecholamines at two hours are probably due to hypoglycaemia.     

METABOLIC OBSERVATIONS IN INFANTS OF STRICTLY CONTROLLED DIABETIC MOTHERS

Abstract. Thirty-five infants of strictly controlled diabetic mothers (IDM), 12 infants of gestational diabetic mothers (IGDM) and 29 control infants were studied to assess the influence of maternal blood glucose level during pregnancy on infant metabolic measurements. At 2 hours after birth the disapperance rate k_t of intravenously injected glucose was determined. Plasma concentration of glucose, insulin, FFA, glycerol and β-hydroxybutyrate were followed in umbilical arterial blood. The 2 hour mean k_t value of IDMs (1.27) was higher (p<0.05) than in IGDMs (1.14) and controls (0.80), but the group mean values were no different at 3 to 5 days although the k_t values were higher. In 10 IDms, k_t values were determined both at 2 hours (1.24) and at 3 days (1.39) without significant differences. Pretest FFA but not glycerol values correlated inversely to k_t values in IDMs and IGDMs. A late insulin peak at 60 min was found in both controls and IGDMs. Insulin responses were unrelated to k_t values. No relation was found between pregnancy glucose value (5 daily determinations during 4 and 2 weeks prior to delivery in DM and GDM respectively) or maternal glucose at delivery and k_t values of IDMs and IGDMs. According to the FFA and glycerol values at 2 hours after birth, 3 sub-groups of IDMs and IGDMs were arbitrarily formed. IDMs and IGDMs of group 1 had glucose, k_ts, FFA, glycerol and β-hydroxybutyrate values no different from controls, whereas sub-groups 2 and 3 showed increasing metabolic deviations. Clinical data and pregnancy glucose levels could not separate the 3 sub-groups. However, the day-to-day variation in maternal glucose was greater in sub-group 3. Mean values of daily maternal blood glucose differences at 10 o'clock correlated to 2-hour k_ts in IDMs. We conclude that strict metabolic control during pregnancy will normalize metabolic adjustment of the infant, thus supporting the maternal hyperglycemia-fetal hyper-insulinism theory.     

FATTY ACID COMPOSITION OF PLASMA AND RED CELL PHOSPHOGLYCERIDES IN FULL TERM INFANTS AND THEIR MOTHERS1

Methods have been adapted and their reproducibility tested for the determination of blood lipids and the fatty acid composition of the phosphoglycerides. The main lipid classes in 20 women from the south-western part of Sweden at term pregnancy and of umbilical cord plasma of their newborn infants were studied. Determinations were made of the fatty acid pattern of plasma phosphoglycerides and of cephalins and lecithin of red cells. The concentration of the major lipid classes in maternal and umbilical cord plasma agreed well with previously reported figures from other countries. The maternal plasma fatty acid pattern of phosphoglycerides was similar to that of adult males. The mothers and their infants had identical concentrations of the total sum of all polyunsaturated fatty acids in plasma phosphoglycerides, in red cell lecithin and in red cell cephalins. The infants' pattern differed from the mothers' by much lower concentrations of the parent fatty acids, linoleic and linolenic acids, and correspondingly increased concentrations of the more polyunsaturated fatty acids of the two series. The fatty acid composition in the red cell lecithin of mother and infant reflected that in the corresponding plasma. The cephalins contained more polyunsaturated fatty acids than the lecithin in both mothers' and infants' red cells. The study produced no biochemical evidence of an essential fatty acid deficiency in these newborns. The identical concentration of total polyunsaturated fatty acids in blood phosphoglycerides of mothers and infants in combination with the pronounced change in the ratio between the parent fatty acids and the highly polyunsaturated derivates, suggest a homeo-static regulation of the fatty acid composition of the blood phosphoglycerides.     

CIRCULATORY ADAPTATION IN NEWBORN INFANTS OF STRICTLY CONTROLLED DIABETIC MOTHERS

ABSTRACT. Possible relations between neonatal circulatory function and maternal diabetic control were investigated in 22 infants of strictly controlled diabetic mothers during the first 2 days after birth. Eleven infants were delivered vaginally (V) and 11 infants by elective cesarean section (S). Maternal diabetes was more severe in the latter group. Half of the infants had one or more episodes of neonatal morbidity although none presented symptomatic hypoglycemia. Plasma glucose FFA and C-peptide were measured at birth and 3-6 hours later together with skinfold thickness; heart size was determined by X-ray at 24-28 hours; stroke volume and cardiac output were repeatedly determined by transthoracic impedance and ECG. C-peptide at birth was higher in group S than in V. C-peptide in both groups were neither related to glucose or FFA nor to birthweight or skinfold thickness. Infants with neonatal complications including cardiomegaly had the highest C-peptide values. Skinfold was positively correlated to maternal pregnancy glucose level, birthweight percentile and infant heart volume. Mean values for stroke volume and cardiac output were similar in both groups and not different from normal controls when related to body weight. Heart volume and stroke volume were significantly related. ECG abnormalities were seen in 6 infants who showed cardiomegaly on X-ray. We suggest that the present finding of an association between elevated C-peptide concentration at birth and the occurrence of neonatal complications including cardiomegaly and ECG abnormalities could be the consequence of functional hyperinsulinism and that the cardiomegaly is of adaptive type.     

EFFECT ON SERUM CALCIUM OF lα-HYDROXY-VITAMIN D3 SUPPLEMENTATION IN INFANTS OF LOW BIRTH WEIGHT, INFANTS WITH PERINATAL ASPHYXIA, AND INFANTS OF DIABETIC MOTHERS

Abstract. Petersen, S., Christensen, N. Chr. and Fogh-Andersen, N. (Department of Neonatology and Department of Clinical Chemistry, Rigshospitalet, Copenhagen, Denmark). Effect on serum calcium of lα-hydroxy-vitamin D₃ supplementation in infants of low birth weight, infants with perinatal asphyxia, and infants of diabetic mothers. Acta Paediatr Scand, 70: 897, 1981.-Thirty infants of low birth weight, 34 infants with perinatal asphyxia, and 16 infants of diabetic mothers were investigated for early neonatal hypocalcaemia. The infants were randomized into a group prophylactically given lα-hydroxy-vitamin D₃, 0.05 or 0.10 μ/kg i.v. on the first 3 days of life, and an untreated control group. In infants of low birth weight and infants of diabetic mothers there were no differences in serum ion-Ca concentrations on days 2, 3, 5, and 7 between the treated and untreated groups. In infants with perinatal asphyxia, however, serum ion-Ca concentrations on days 5 and 7 were significantly higher in the treated than in the untreated group, while on days 2 and 3 the differences were not statistically significant. The hypocalcaemia in asphyctic infants was not correlated to bicarbonate treatment, but infarits with severe signs of asphyxia had lower serum ion-Ca concentrations than infants with only mild or no signs. Hypocalcaemia in asphyctic infants might be explained by a decreased concentration of 1 α, 25-dihydroxy-vitamin D₃ following reduced lα-hydroxylation in the kidney as a consequence of anoxia during perinatal asphyxia.     

METABOLIC EVENTS IN INFANTS OF DIABETIC MOTHERS DURING FIRST 24 HOURS AFTER BIRTH III.

ABSTRACT. Plasma amino acid concentrations (AAC) were studied in 31 diabetic mothers (10 of White class A, 10 of B-C and 11 of D-F) and their 32 infants during the first 24 hours after birth. Only minor differences between the 3 groups were found at birth and 2 hours, and none at 12 and 24 hours after birth. The individual AAC in umbilical vein plasma did not correlate with birthweight. All AAC except aspartic acid, aspargine, cystine and glutamic acid were higher in umbilical venous plasma than in maternal plasma. Umbilical venousarterial differences of amino acids did not correlate with maternal or umbilical vein insulin concentrations except for threonine and valine. In general essential amino acids decreased after birth. In 8 infants with hypoglycemia and hyperinsulinism at 2 hours of age several plasma amino acids were lower than in the normoglycemic infants.     

METABOLIC EVENTS IN INFANTS OF DIABETIC MOTHERS DURING FIRST 24 HOURS AFTER BIRTH I.

ABSTRACT. Changes in plasma glucose, nonantibody-bound insulin and glucagon concentrations were studied in 32 newborn infants of diabetic mothers (IDM) during the first 24 hours after birth. Ten infants were born to White class A mothers and 22 to class B-F mothers. The infants were kept fasting during the investigative period and blood was sampled from an umbilical artery catheter. At birth, plasma glucose and glucagon levels were similar in the class A and B-F infants, whereas nonantibody-bound insulin levels were approximately 15-fold higher in the class B-F infants than in the class A infants (p<0.001). After birth, plasma glucose fell in all infants, the nadir being reached at two hours (p<0.01). Plasma glucose fell by approximately 35 % in the class A infants and 63 % in the class B-F infants (p<0.01). Eight IDM had asymptomatic hypoglycemia (plasma glucose <1.9 mmol/l) and four of these infants had glucose levels below 1.7 mmol/l and were withdrawn from further study. In the remaining four hypoglycemic IDM, plasma glucose was about 1.6-fold higher (p<0.01) and insulin about 11-fold higher (p<0.001) at birth compared to the 24 normoglycemic IDM. The hypoglycemia was attended by unchanged insulin levels in the class A infants, whereas insulin fell in the class B-F infant (p<0.01). However, during the whole investigative period, plasma insulin of the class B-F infants was higher than that of the class A infants (p<0.01). After birth, plasma glucagon increased slowly in all IDM and peak values were reached after 12 hours in the class A infants (p<0.05) and 24 hours in the class B-F infants (p<0.01). Only those infants who became hypoglycemic after birth exhibited a significant increment in plasma glucagon from 0-2 hours (p<0.05). These results suggest that neonatal hypoglycemia of IDM results from high plasma levels of nonantibody-bound insulin together with a very retarded increment in plasma glucagon levels. The degree of neonatal hypoglycemia and hyperinsulinemia of an individual IDM seems to be positively correlated to the severity of the diabetes of the mother.     

METABOLIC EVENTS IN INFANTS OF DIABETIC MOTHERS DURING FIRST 24 HOURS AFTER BIRTH II.

ABSTRACT. Changes in plasma glycerol (FG), free fatty acids (FFA) and triglyceride (TG) were studied in 24 normo- and 8 hypoglycemic infants of diabetic mothers (IDM). In both groups a normal rise in plasma FG 2 hours after birth was found indicating unimpaired lipolysis. The rise in plasma FFA, however, was only about 50% of normal in normoglycemic IDM and about 25% of normal in hypoglycemic IDM. The rise in plasma TG was normal in normoglycemic and about 70% of normal in hypoglycemic IDM. The 2 hour rise in plasma FFA correlated with the 2 hour concentration of insulin and glucose, whereas the rise in plasma FG and TG did not. Maternal plasma FFA correlated with fetal FFA retention (unbilical vein minus artery (V-A) FFA concentrations). No correlations were found between maternal plasma FFA values and birth-weights nor between umbilical V-A FFA concentrations and birth-weights.     

THE INFLUENCE OF THE PLACENTAL TRANSFUSION ON THE CAPILLARY BLOOD GAS AND ACID-BASE BALANCE IN THE NEWBORN INFANT

Of 77 normal newborns, 42 were clamped early while 35 were clamped late. Using capillary blood from an unwarmed heel, the hema-tocrit and the acid-base balance of the two groups were compared. During the first day of life the hematocrit of late-clamped newborns was fairly constant and higher than that of early-clamped babies, the latter showing a definite fall 2–24 hours after birth. Regarding the acid-base balance, no difference was found between the two groups of newborns except when measurements were performed 3–5 hours after birth. At this time actual pH and standard bicarbonate were lower in late-clamped babies than in early-clamped, while P_CO2 was identical. On the basis of the hematocrit findings it is proposed that the placental transfusion, by creating oedema of the interstitial space, may contribute to the well known discrepancy between the acid-base status of the capillary and the arterial blood of the newborn.     

METABOLIC OBSERVATIONS IN INFANTS OF STRICTLY CONTROLLED DIABETIC MOTHERS Plasma Levels of Glucose, FFA, Glycerol and D-β-hydroxybutyrate during the First Two Hours after Brith

Arterial concentrations of FFA, glycerol, glucose and D-β-hydroxybutyrate were serially measured during the first 2 hours after birth in IDMs, IGDMs and in control infants. All diabetic mothers were subjected to a well defined program of control during pregnancy. IDMs had only a slight increase in mean plasma FFA concentrations and the values were significantly lower than those of the IGDM and control groups at all times. In contrast the rise in mean plasma glycerol values was significant and similar in all groups, suggesting a comparable increase in lipolysis. Following birth IDMs showed a more pronounced decrease in mean plasma glucose values than the other groups. Mean plasma values of D-β-hydroxybutyrate showed a significant drop during the first 60 minutes and thereafter the values remained low and were not significantly different between the groups. The pattern of changes in FFA, glycerol and glucose was not influenced by type of delivery, duration of diabetes and/or presence of retinopathy in the mothers, nor was there any apparent relationship to the degree of maternal metabolic control during pregEancy. It is suggested that the low mean FFA levels despite of increasing mean glycerol concentrations in IDMs are explained by an increased rate of re-esterification of FFA withi!i adipose tissue. Thcse findings can only partly be explained by postnatal functional hyper-insulinism. The recent demonstration af higher than normal glycogen concentrations within adipose tissue in IDMs cffers a more plausible explanation for the increased rate of re-esterification during the first hours after birth. The p;esent data do not allow of conclusions as to thc relative importance of increased glycogen stores as compared with that of hyperinsulin-ism during the first 2 hours after birth in IDMs.     

PYRIDOXAL PHOSPHATE CONCENTRATION IN BLOOD IN NEWBORN INFANTS AND THEIR MOTHERS COMPARED WITH THE AMOUNT OF EXTRA PYRIDOXOL TAKEN DURING PREGNANCY AND BREAST FEEDING

Abstract. Ejderhamn, J. and Hamfelt, A. (Departments of Paediatrics and Clinical Chemistry, Sundsvalls Hospital, Sundsvall, Sweden.) Pyridoxal phosphate concentration in blood in newborn infants and their mothers compared with the amount of extra pyridoxol taken during pregnancy and breast feeding, Acta Paediatr Scand, 69:327, 1980.—The concentrations of pyridoxal phosphate have been estimated in cord blood and capillary blood samples taken at 3 hours, 2 days, 4 days, 7 days and 6 weeks of age, from eleven fullterm infants. Pyridoxal phosphate concentrations were also determined in venous blood samples taken from the mothers at delivery. A highly significant correlation between pyridoxal phosphate in cord whole blood and venous whole blood taken from the mothers at delivery was found. Infants whose mothers had taken extra pyridoxol during pregnancy had a higher concentration of pyridoxal phosphate at 3 hours of age compared with infants whose mothers had not taken extra pyridoxol. During the first week of life the concentration of pyridoxal phosphate in capillary blood decreases strikingly. At 6 weeks of age the concentration of pyridoxal phosphate is in the same range as that of normal adults. Findings are also discussed which indicates that: 1) Vitamin B₆ is transported in breast milk; 2) The giving of supplemental pyridoxol during pregnancy in ordinary doses (2–6 mg/day) does not have an antilactogenic effect. No correlation between the erythrocyte aspartate aminotransferase activation with pyridoxal phosphate in vitro and pyridoxal phosphate concentration in plasma was found during the first 6 weeks of life.     

THE EFFECT OF FEEDING ON OXYGEN CONSUMPTION, RQ AND PLASMA LEVELS OF GLUCOSE, FFA, AND D-β-HYDROXYBUTYRATE IN NEWBORN INFANTS OF DIABETIC MOTHERS AND SMALL FOR GESTATIONAL AGE INFANTS

Abstract. Eight infants of strictly controlled diabetic mothers (IDM), 8 infants of gestational diabetic mothers (IGDM) and 6 small for gestational age infants (SGA) were studied before the first feeding and during an early feeding regimen. In IDMs and IGDMs continuous monitoring from 2 hours up to 7 1/2 hours after birth before feeding revealed no consistent changes of Vo₂ and RQ. The groups of infants were studied on 4 different occasions: (I) 2 to 16 hours, (II) 1 to 2 days, (III) 3 to 4 days, and (IV) 7 to 11 days. Prefeeding Vo₂-values were not significantly different between each of the groups, but mean RQ was higher in IGDMs than in IDMs. Age of the infant and prefeeding RQ were inversely correlated (r=-0.537, p<0.02). With increasing age and milk intake Vo₂ increased significantly in all groups. RQ decreased during the first 24 to 48 hours in all groups and rose thereafter with highest values at 7 to 11 days. Plasma levels of glucose, FFA, and D-β-hydroxybutyrate were not significantly different between each of the groups. The highest values for D-β-hydroxybutyrate were found at 1–2 days when the lowest RQ values were also recorded. D-β-hydroxybutyrate concentrations and RQ values (r= -0.648, p<0.001) were inversely correlated suggesting increasing oxidation of fat. Feeding resulted in a marked rise in RQ to values around unity, which preceded a distinct increase in Vo₂ that reached a maximum at 1 to 1 1/2 hours after the feed, then slowly returned to pretest values. The rise in Vo₂ was accompanied by an increase in rectal temperature (0.4 to 1.5°C). Vo₂, RQ, and plasma levels of glucose, FFA, and D-β-hydroxybutyrate, were almost identical for each of the groups. We suggest: 1) That differences in feeding practice is the most likely explanation for the discrepancy between reported values for Vo₂, RQ, and circulating substrates in normal and low birth weight newborns. 2) That the rise in Vo₂ during the neonatal period, caused by feeding, reflects the cost of growth.     

INFLUENCE OF MATERNAL GUT FLORA AND COLOSTRAL AND CORD SERUM ANTIBODIES ON PRESENCE OF ESCHERICHIA COLI IN FAECES OF THE NEWBORN INFANT

ABSTRACT. From 29 healthy newborn infants and their mothers faecal, serum and milk specimens were obtained on several occasions from one to nine weeks after delivery. Predominant faecal E. coli were serotyped with regard to the O antigen and milk and serum were analysed for their content of E. coli O antibodies by the enzyme-linked immunosorbent assay. In five cases the babies acquired the same O serotype as was found in the stools of their mothers but in 12 out of 29 cases infant and mother never had any dominating faecal E. coli O type in common. There was no apparent correlation between the patterns of feeding and interchange of bacteria. Klebsiella/Enterobacter was the dominating facultative organism on at least one occasion in half the infants. The newborns received coiostral IgA and transplacental circulating IgG antibodies against a great number of E. coli O serotypes. These antibodies did not prevent intestinal colonization, as judged from cultures of faeces.